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M&NIFIED PROGRAM CONSOLIDATED FORAjdk UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) VI.UNDER DISPENSER CONTAINMENT C) ORING 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 490-54 490-54bb ❑ 1.CONTINUOUS ELECTRONIC MONITORING ❑2.FLOAT AND CHAIN ASSEMBLY (3.ELECTRONIC STAND-ALONE ❑4.NO DISPENSERS ❑99.OTHER( ify): PANEL MANUFACTURER: 49x55 MODEL#: —+ 3.Y'::) 490-56. LEAK SENSOR MANUFACTURER: 490 57 ( MODEL#(S): ,D S-7490-58 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑b.NO 490-59 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN S ❑b.NO 490-60 FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. hff a.YES ❑b.NO 490-61 UDC MONITORING STOPS THE 24W OF PRODUCT AT THE DISPENSER. YES ❑b.NO 490-62 2.UDC CONSTRUCTION IS .SINGLE-WALLED ❑2.DOUBLE-WALLED 490-63 IF DOUBLE WALLED: 4a UDC INTERSTITIAL SPACE IS MONITORED BY: ❑1.LIQUID ❑2.PRESSURE ❑3.VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a YES ❑b.NO 49"4b VII.PERIODIC SYSTEM TESTING ❑ 1. D TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490-65. LEAK DETECTION LD MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED.(23 CCR§2644.1) 2 CONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490-66 3.SPILL BUCKETS ARE TESTED ANNUALLY. 490-67 VIII.RECORDKEEPING Thyfollowing monitoring/maintenance records are kept for this facility: Alarm logs 490-68a ❑Visual Inspection Records 49omb ❑Tank integrity testing results 490-68c ❑ SIRjesting results(and supporting documentation records). 49o-6w ❑ Tank gauging results(and supporting documentation records). 490-68e ❑ Testing results(and supporting documentation records).490-68f ❑ Corrosion Protection 60-day logs 49a68e quiprix aintenance and calibration records. 4go6sn IX, G ersonnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 490-6% REFE CE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) S TW, STORAGE TANK MONITORING PLAN(Required)490-69b PERATING MANUALS FOR ELECTRONIC MONITORING EQUIP (Required)49"9c ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490-69d ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490-69e ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND S ATISTICAL INVENTORY RECONCILIATION"490-W ❑ 9WRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"490-698 OTHER(Specify):M69h,M69i This facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council(ICC). 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: ➢ 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 equipment as specified in this UST Monitoring Plan ➢ The facility employee's role with regard to spills and overfills as specified in the UST Response Plan ➢ Names of contact person(s)for emergencies and monitoring alarms.49o-7o X. COMMENTS/ADDITIONAL MORMATION Provide additional comments here or indicate how m y pages with additional information specific monitoring procedures are attached to this an.490-71 t✓ � L' t t G74iV L.` XI,PERSONNEL RESPONSIBILITIES 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 this plan occurs,2)all conditions that indicate a possible release are investigated,and 3)all monitoring records are maintained properly. The following pe n(s) resp. ib r orm' g itorm and equipment maintenance: NAME (,, 490.72 TITLE 490-73 NAME490-74 TITLE 490-75 The Designated Ope hall perform a monthly visual inspection of the facility,provide a report to thowner/operator, and inform the owner/operator of any conditions that need foil. -up action. XII.OWNER/OPERATOR SIGNATURE CERTIFICAT!P4.j certify that the information provided herein is true and accurate to the best of my knowledge. APPLICANT SIGNA 490-76 DATE: 490-77 y t E / 2.F f APPLICANT NAME(print): 490-78 APPLICANT TITLE: 490-79