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0 0 <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANK <br /> MONITORING PLAN- age 2 of 2 <br /> VI.UNDER DISPENSER CONTAINMENT C MONITORING (Check&[! <br /> (�' }.:, that a` <br /> UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) <br /> ® 1.CONTINUOUS ELECTRONIC MONITORING ❑ 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE 490-54& <br /> ❑ 4.NO DISPENSERS ❑ 99.OTHER(Specify) 490-54b. <br /> LEAK MONITOR MANUFACTURER:Veeder-Root 490-55. MODEL#:TLS-350 k <br /> 490-56. <br /> LEAK SENSOR MANUFACTURER:Veeder-Root 490-57. MODEL#(s):794380-352 490.58. <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 /> UDC CONSTRUCTION IS: ® 1.SINGLE WALL ❑ 2.DOUBLE WALL 490.63. <br /> IF DOUBLE WALL: 490.64& <br /> UDC INTERSTITIAL SPACE IS MONITORED BY: ❑ a.LIQUID ❑ b.PRESSURE ❑ c.VACUUM <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 /> ❑ 1.ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490-65, <br /> LEAK DETECTION ELDMUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED.123 CCR§2640-.11 <br /> 2. SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490-66. <br /> ® 3.SPELL BUCKETS ARE TESTED ANNUALLY. 490-67. <br /> VIII, RECORD KEEPING <br /> The following monitoring/maintenance records are kept for this facility: 490-68. <br /> ® a.ALARM LOGS ❑ b.VISUAL INSPECTION RECORDS ❑ c.TANK INTEGRITY TESTING RESULTS <br /> ❑ d.SIR TESTING RESULTS(and supporting documentation records) ❑ e.TANK GAUGING RESULTS(and supporting documentation records) <br /> ® f.ATG TESTING RESULTS(and supporting documentation records) ❑ g.CORROSION PROTECTION 60-DAY LOGS <br /> ® h.EQUIPMENT MAINTENANCE AND CALIBRATION RECORDS <br /> IX. TRAINING <br /> Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties: 490-69& <br /> REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) <br /> (� THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) 490.69b. <br /> ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) 490-69c. <br /> ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490-69d. <br /> ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490-69e. <br /> ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND 490-69f. <br /> STATISTICAL INVENTORY RECONCILIATION" <br /> ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 490-69s. <br /> ❑ OTHER(Specify): avo ago-69i. <br /> 60-. <br /> ® This facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council 490-70. <br /> (ICC). The "Designated UST Operator"will train facility employees in the proper operation and maintenance of the UST systems annually,and within 30 <br /> days of hire.This 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 facility's UST Response Plan. <br /> ➢ Name(s)of contact person(s)for emergencies and monitoring alarms. <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 /> Overfill Protection-Flapper <br /> XI. PERSONNEL RESPONSIBILITIES <br /> The UST Owner/Operator is responsible for ensuring that: l.)the daily/routine UST monitoring activities and maintenance of UST leak detection equipment covered <br /> Py this plan occurs;2.)all conditions that indicate a possible release are investigated;and 3.)all monitoring records are maintained 3 operly. <br /> THE FOLLOWING PERSON(S)ARE RESPONSIBLE FOR PERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE: <br /> NAME: Deanne Rotta 490-72. TITLE:Environmental Compliance Specialist 490-73. <br /> NAME: Jivtesh Gill 490-74. TITLE:Franchisee 490-75, <br /> The Designated UST 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 /> CERTIFICATION:I certify that the information provided herein is true and accurate to the best of my knowledge. <br /> APPLICANT SIGNATURE DATE: 490-77, <br /> 5/13/2011 <br /> REPRESENTING❑1.Tank Owner/Operator❑2. aci iy Gwner/O a or 3.Authorized RepresffltativedOwna 4901-76. <br /> APPLICANT NAME(print): 490-78. APPLICANT TITLE: 490-79. <br /> Deanne Rotta Env. Compliance Specialist <br /> UPCF UST-D(12/2007)-3/4 www.unidoes.org <br />