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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) VI. UNDER DISPENSER CONTAINMENT (UDC) MONITORING 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 490-54a 490-54b El 1. CONTINUOUS ELECTRONIC MOMTORING El 2. FLOAT AND CHAIN ASSEMBLY ❑ 3. ELECTRONIC STAND-ALONF, El L NO DISPENSERSE399- OTHER (Specify). ----------------- .... . .............. ....... ..................... .-------------*--------------- ---------- M-56PANELNIANUFACTURER �IOD19' -----------*------------------------------ - _— ------------*........................ LEAK SENSOR MANUFACTURER: 4W-57 1 6 . 4M-59 #(S): DETECTION OF A LEAK INTO -1 HE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS 0 a YES El b, NO 4"n se UDC LEAK ALARM TRIGGERS AUTOMATIC Pumi, SHUTDOWN L] a YES 0 b. NO FAILURE/ DISCONNECTION OF UDC MONITORING SYSTEM -TRIGGERS AUTOMATIC PUMP SHUTDOWN. El a. YES El b, No UDC MONITORING S-TOPS TI Ir FLOW OF PRODUCT AT THE DISPENSER. 0 a, YES El b. NO M-62 2. UDC CONSTRUCTION IS Ell-SINGLEAVALLED [11DOUBLE-WALLED M-63 IFDOUBLE WALLED: --•4990=i- 4 UDC INTERS-111(AL SPACE IS MONITORED BY, ES SURE 0 3. VACUUM !� ------- - __ ------ ------ .... ------- ------------ .. . ...... 1-1 ... ............. A LEAK WITHIN THE SECONDARY CONTAINNIENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS Ela YES El b- NO 49464b VII, PERIODIC SYS'T'EM TESTING El I ELD TESTING._ THIS FACILITY HAS BEEN NOTIFIED—BY—NE S'T'ATE WATER RES&IJRCES CON'T'ROL —BOARD THAT F_NHANCED 490-65 LEAK DETECTION (ELD) MUST BE PERFORMED. PERIODIC rLD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. (23 CCR §2644. 1) - OW - I ........................ --------------- -------- ---------- ------------------- .... .... _ ------- ------- 2'2, SECONDAl1YCON'rAlN,%IFXT COMPONENTS ARE TESTED EVERY 36 MONTHS 4%66 ._____ ---------------------------- ---------- ----------------- --------- ------------- -------- ---- ---------- — --- I------- -�3- -S-P-11 C_ K X ik E TESTED A N N UA 1, 1, 1'. 490.67 VIII. RECORDKEEPING The following monitoring/maintenance records are kept for this facility: [`Alarm logs 4th)-ma ER Visual Inspection Records 4-m-6sb ElTank integrity testing results 4wo-(-4c [I SIR testing results (,and supporting documentation records). 4'X46Sd El Tank gauging results (and supporting documentation records), 4-x)-on, El ATG Testing results (and supporting documentation records). 4VJ*Sf E] Corrosion Protection 60-clay logs mi-rsg El Equipment maintenance and calibration records. 4'X468h IX. TRAINING &-versonnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties, 4,A4 REFERENCE DOCUMENTS MAINTAINED AT FACHA I'Y (Check all that apply) Eq'I His UNDERGROUND STORAGE-. TANK MONITORING PLAN (Required) s941-01h ®-OPERATING MANUALS FOR l:;.FCTRONIC MONITORING EQUIPMENT (Required) 4,n 0 CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS vm-t�qd WCALIFORNIA UNDERGROUND STORAGE TANK LAW flJ`STATL WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION" 4M-0)f EJ'SWRCB PUBLICATION: "UNDERSTANDING AUTONIATICTANK GAUGING SYSTEMS" 4-x1.(og Ej OTHER (Specify): nt69h- timet. (n� 1 his facility has a "Designated UST Operator" who has passed the California UST System Operator Exam administered by the International Code Council ([CC), 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 training will include, but is not limited to, the following: 3" Operation of the UST systems in a manner consistent with the facility's best management practices > The facility employee's role with regard to the monitoring eqtiipiiientasspecificd in this UST Monitoring Plan > The facility employee's role with regard to spills and over fillsas specified in the UST Response Plan Names of contact person(s) for emergencies and monitoring alarms. 490-7.) X. COMMENTS/ADDITIONAL INFORMATION Provide additional comments here or indicate how many pages with additional information on specific monitoring procedures are attached to this plan- 4w-71 X1. PERSONNEL RESPONSIBILITIES The USTOwner/Operator is responsible for ensuring that: 1) the daily/routine UST monitoring activities and maintenance of UST leak detection equipment covered by this plan occurs, 2) a0 conditions that indicate a possible release are investigated, and 3) all monitoring records are maintained properly. The follm M* persons)are resp si r performing the monitoring and equipment mai"017ci, r I t 111 k (___ P/16/dy/ut_ I 49o-72 TITLE 4W-71 NAME 4%L74 TITLE, 4,X),15 The Designated Operator shall perforin a monthly visual inspection of the facility, provide a report to the owner/operator, and inforin the omierloperatur of any conditions that need follow-up action. ----------- --- X11. ONVNER/OPFRATOR SIGNATURE CERTIFICATION: I certify that I t lie i n forni ill ion provided herein is true and accurate to the best o I* it i), knovk ledge. A I'll L ICA N I'Sl G 4N,trU R I. /146PUC DATE 4"),).17 'Zo I [32 rh.PL_ r 0g,ul, _ E3 APPLICANT NAME (print) au 490-7X APPLICANTTITLE: u PcF us -r -r) (I M007) 314