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VNEFIED PROGRAM CONSOUDAbW FORM <br /> UNDERGROUND STORAGE TANK <br /> MONITORING PLAN <br /> (r aof2) <br /> TVL UNDER <br /> - . 490,56 <br /> CO NIC ING 2 T Ass LY DISPENSERCONTO O G <br /> G is c FOLLOWING n <br /> C STAND"NE <br /> 4.No DISPENSERS 13 99.OTHERS <br /> PANEL MANUFACTUREILs MODEL#: <br /> LEAK SENSOR A e a.•J 49M7 MOD>:t.#(S): p49948 <br /> BiTECTION OFA LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS E3 a YES M No 4904" <br /> UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN WL YES 13b.NO moo• <br /> FAIL /DISCONNBCTION OF UDC MONITORWO SYSTEM TRIGGERS AUTOMATIC pUMp SHUTDOWN. a YES 13 h NO t <br /> UDC MONITORING STOPS OF PRODUCT AT THE DISPENSER. YES OhNO <br /> 2.uDc comsmumoN IS .smaL&w 2Doum-wAum 49043 <br /> IF DOUBLE W <br /> UDC MEWMAL SPACE IS MONITORED BY131.LI UID CL&_PRBSURE Q 3.VACUUM <br /> A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS E3 a YES E3 h NO <br /> VM ODIC G <br /> 13 t.FLD I TING: FACILITY HAS BEEN NOTIFW BY THE STATE WATER RESOURCES CONTROL J30ARD THAT <br /> MUSTBEPEMRMED PERIODIC ELD ISLERFORMED EVERY 36 MONTHS AS MLqRED 23 CCR 2644.1 <br /> SECONDARY CONTAINMIINT COMPONENTS ARE TESTED EVERY 36 MONTH& 40" <br /> 3.SPILL BUCKETS ARE TESTED ANNUALLY. r <br /> VIMRECORDICEEMG <br /> foli records ase kept for this ficiW. <br /> logs vismallbspaction Records 490-Ub mmity testing results <br /> s. <br /> SIR testing results( ) mom ❑Taannk is(andp o 6ting doctiotentstion �* <br /> ATG T (and SWPXtMg&MM=tlb=r=Cft) Iogs 4u-ft <br /> mainteriance and calibration momids. m.(& <br /> DL TRAINING <br /> %Xasonnel with UST mordwring responsibilities are familiar with all oftbe fbuowmg docmam rdmm to tleir job did= 40-61 <br /> REFERENCE DOCUMENTS MAINTAINED AT FACHiTy <br /> m THIS UNDERGROUND STORAGE T MONITORING ( �) <br /> LAN(Required)4%.m <br /> TING mANuALs FOR ELwmmc MONITORING EQUIPMENT ) <br /> CALEFORNIA UNDERGROUND STORAGE TANK REGULATIONS <br /> CALWORNIA UNDERGROUND STORAGE TANK LAW <br /> STATE WATER RESOURCES CONTROL BOARD ( ) PUBLICATION: "HANDBOOK FOR TANK O - MANUAL AND <br /> STATISTICAL DCA24MRY RECONCHIATION"4mm <br /> SWRCB PUBLICATION. ANDWG AUTOMATIC TANK GAUGING SYSTEMS"4 <br /> 13 OTHER(spm*):kwk am <br /> is facility has a" USf who has the California UST System by the Code (ICC). <br /> UST will facility in the POW operation and nummiam of the UST system <br /> trainiq will include,but is not i' to,the fo Y. 30 of him This <br /> • Operation ofthe UST System in a mmw consistent with the facility's best rmmgmm practicaa <br /> 9 The finality employWs sok with regard to the monitain equiprom as specified in this UST Monitoring Pian <br /> A The fin;ility 's role vn&regaid to spdb and overfills as specified in the UST Respom plan <br /> • Noines of s)for and nionscring alsting 4m7o <br /> X COARMOGNADDMONAL INFORMA170N <br /> Provide additional conments late or indicate how many Pon with additional inforination on specific monitoring procedines are Mcbed to this plan.4sa71 <br /> J eC ®t` Cel ® a1 �!U c, ` ( a►, <br /> XL PERS6NNEL RESPONAMUXM <br /> The UST Ownuffipuuw is responsible for ensuring that t)the daily UST nwniMfing activities and nmmtmmw of UST leak detection quipment covered by <br /> this pia occurs,2)all conditions dot indicato a possible release are mmilgaaA and 3)all niontiornig records ate nmntmrgd properly. <br /> The foil s) lnle for perithe rraaitoring and <br /> NAME 4M72 TITLE f 0%S,l K4 me ` 4x6.73 <br /> NAME 1 4W74 TITLE _ 4M75 <br /> The Designated Opmt&shall pedbrm a of the fa6ility,provide a report to the owaidoperaw,and inform the ownedopmaw of any <br /> conditions that need follow-up <br /> XM OWNMOPERATOR SHPIATURE <br /> CE CATION:I cerfify that the information ded herein is true and accurate to the best of m <br /> APPLICANT SIGNATURE 4m76 DATE: 4W77 <br /> 131 Tma—m-01—mommum <br /> liq I®1 <br /> APPLICANT NAME(print):_ 78 APPLICANT ( 4M79 <br /> ti <br /> UPCF UST D(1 3/4 <br />