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Ah <br />r1 <br />—UNIFIED PROGRAM CONSOLIDATED FORM <br />UNDERGROUND STORAGE TANK <br />MONITORING PLAN (Page 2 of 2) <br />VI. UNDER DISPENSER CONTAINMENT (UDC) MONITORING <br />1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 490.54a <br />490-54b <br />❑ 1. CONTINUOUS ELECTRONIC MONITORING ❑ 2. FLOAT AND CHAIN ASSEMBLY ❑ 3. ELECTRONIC STAND-ALONE <br />❑ 4. NO DISPENSERS ❑99. OTHER (Specify) -- – ------ ---------- <br />– – – – – – – --- – – –– --- r– <br />490-55 490.56. <br />PANEL MANUFACTURER: { MODEL #: <br />--- <br />- - - ----------------------------------------------------------------------- -------------------------- <br />LEAK SENSOR MANUFACTURER: 490 57 I MODEL #(S): 490-58 <br />DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑ a. YES ❑ b. NO 490.59 <br />UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN ❑ a. YES ❑ b. NO 490-60. <br />FAILURE / DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a. YES ❑ b. NO 490-61 <br />UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. ❑ a. YES ❑ b. NO 490-62 <br />2. UDC CONSTRUCTION IS ❑1. SINGLE -WALLED ❑ 2. DOUBLE -WALLED 490.63 <br />IF DOUBLE WALLED: 490-64a <br />INTERSTITIAL SPACE IS MONITORED BY: I LIED_ 0 2. PRESSURE ❑ 3_ VACUUM-------------------------------------------- —_—_____ <br />— _UDC <br />A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑ a. YES ❑ b. NO 490-641 <br />VII. PERIODIC SYSTEM TESTING <br />❑ I. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490.65. <br />___LEAK DETECTION (ELD) MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED__(23 CCR_§2644.1) _— <br />[Z'2. SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS 490-66 <br />-- ------------- <br />---------------------------------------------------------------------------------------------------- - ---------------------------- <br />3 SPILL BUC-KETS ARE TESTED ANNUALLY. 490.67 <br />VIII. RECORDKEEPING <br />The following monitoring/maintenance records are kept for this facility: <br />[> rAlarm logs 490.688 [a'Visual Inspection Records 490-68b ❑ Tank integrity testing results 490-68c <br />❑ SIR testing results (and supporting documentation records). 490-68d ❑ Tank gauging results (and supporting documentation records). 490-68e <br />❑ ATG Testing results (and supporting documentation records). 490-68f ❑ Corrosion Protection 60 -day logs 494688 <br />❑ Equipment maintenance and calibration records. 490-68h <br />IX. TRAINING <br />[TPersonnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 490-69a <br />REFERENCE DOCUMENTS MAINTAINED AT FACILITY (Check all that apply) <br />[]'THIS UNDERGROUND STORAGE TANK MONITORING PLAN (Required) 490-69b <br />[0 -OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT (Required)490-690 <br />0' CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490.69d <br />[CALIFORNIA UNDERGROUND STORAGE TANK LAW 490.69e <br />ED -STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND <br />STATISTICAL INVENTORY RECONCILIATION" 490.69f <br />[t."SWRCB PUBLICATION: "UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 490-698 <br />❑ OTHER (Specify): M69h, M69i <br />®'This facility has a "Designated UST Operator" who has passed the California UST System Operator Exam administered by the International Code Council (ICC). <br />The "Designated UST Operator" will train facility employees in the proper operation and maintenance of the UST systems annually, and within 30 days of hire. This <br />training will include, but is not limited to, the following: <br />➢ Operation of the UST systems in a manner consistent with the facility's best management practices <br />➢ The facility employee's role with regard to the monitoring equipment as specified in this UST Monitoring Plan <br />➢ The facility employee's role with regard to spills and overfills as specified in the UST Response Plan <br />D Names of contact person(s) for emergencies and monitoring alarms. 490.70 <br />X. COMMENTS/ADDITIONAL INFORMATION <br />Provide additional comments here or indicate how many pages with additional information on specific monitoring procedures are attached to this plan. 490.71 <br />(6A � cc fi C(1:; �%) <br />XI. PERSONNEL RESPONSIBILITIES <br />The UST Owner/Operator is responsible for ensuring that: 1) the daily/routine UST monitoring activities and maintenance of UST leak detection equipment covered by <br />this plan occurs, 2) all conditions that indicate a possible release are investigated, and 3) all monitoring records are maintained properly. <br />The following person(s) are responsible for performing the monitoring and equipment maintenance. <br />NAME 490-72 TITLE 490-73 <br />NAME 490-74 TITLE 490-75 <br />The Designated Operator shall perform a monthly visual inspection of the facility, provide a report to the owner/operator, and inform the owner/operator of any <br />conditions that need follow-up action. <br />XII.OWNER/OPERATOR SIGNATURE <br />formation provided herein is true and accurate to the best of my knowledge. <br />CERTIFICATION: I certify that the iin� <br />APPLICANT SIG 49046 <br />TURF 1,/C�)�� <br />n <br />DATE: 490x7 <br />I "" " <br />REPRESENTING: El I. Tank Owner/Operator 0 2. Facility Owner/operator rl 3. Authonzed Representative of Owner <br />APPLICANT NAME (print): Mau t ( C('�LI 490-78 <br />APPLICANT TITLE: (� . 490-79 <br />I SI <br />UPCF UST -D (12/2007) 3/4 <br />