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MIN E IED pROGRAM CONSOLIDATED FOR UNDERGROUNDSTORAGETANK MONnORINGPj� - a e2of2) ' (Chck all VI.UNDER DISPENSER CONTAINMENT MONITORING that UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) 490-54a ® 1.CONTINUOUS ELECTRONIC MONITORING ❑ 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STANDALONE 490-54b. ❑ 4.NO DISPENSERS ❑ 99.OTHER(Specify) 490-s6. a�-ss. MODEL#:TLS-350 LEAK MONITOR MANUFACTURER:V@@d@r Root ago s7490-58. LEAK SENSOR MANUFACTURER:Veod@r Root MODEL#(S):208 a.YES ❑ b.NO 4w9- DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ® a.YES [Ib.NO 4"-60UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN. 49"1. UD FAILURE/DISCONNECTION OF C MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ® a.YES ❑ b.NO ® a.YES ❑ b.NO 49"2- UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. 490-65 t.SINGLE WALL ❑ 2.DOUBLE WALL UDC CONSTRUCTION IS: ® a IF DOUBLE WALL: a LI UID ❑ b.PRESSURE ❑ c.VACUUM UDC INTERSTITIAL SPACE IS MONITORED BY: ❑ Q 490-64b. A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ® a.YES ❑ b.NO . PERIODIC SYSTEMTESTING 45. 1.ELD TESTING THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOEAT ENHANCED LEAK DETE ON LD MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS RE Iu ccR§2644.11 4966 ® 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490.67. ® 3.SPILL BUCKETS ARE TESTED ANNUALLY. CO KEEPING 4vaba. The following monitoring/maintenance records are kept for this facility: ® aULTS .ALARM LOGS b.VISUAL INSPECTION RECORDS ❑ e.Tc. ANNK GAUGING RESULTS(and K INTEGRITY TESTING supporting documentation records) ❑ d.SIR TESTING RESULTS(and supporting documentation records) ❑ ® f ATG TESTING RESULTS(and supporting documentation records) ❑ g.CORROSION PROTECTION 60-DAY LOGS ® h.E UIPMENT MAINTENANCE AND CALIBRATION RECORDS TRAINING 490-69a- REFERENCE go bva Personnel with UST monitoring responsibilities are familiar with all of the following is relevant to their job duties: REFE CE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) 490-6%. THISUNDERGROUND STORAGE TANK MONITORING PLAN(Required) 490-W OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) 490-9a ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490-6%_ ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND 490-W. STATISTICAL INVENTORY RECONCILIATION 490598. ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 490-691. 4"i. ❑ OTHER(Specify): ys Qpetat 490 70. This facilityhas a"Designated UST operator"who has passed the California UST S tem or Exam administered by the International Code Cauncit (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 facility's UST Response Plan. D Names)of contact persons)for emergencies and monitoring alarms. X. COMMENTS/ADDITIONAL INFORMATION 490 71 Provide additional txamments here or indicate how many pages with additional information on specific monitoring procedures are attach to this plan. _ _ g 1.. j A �y g ,y i N p r @i° °°•° ; �J ',..f ` _ . L' 4 l A �1°' ��' P 1�Sgj s fe^� i3°rte $ o.S 'Sd t a�� f @^ b l e PERSONNELR ESPONSIBILITIES The UST Owner/Operator is responsible for ensuring that: l.)the daily/routine UST monitond maim of UST leak detection equipment covered b this Ian occurs;2. all conditions that indicate a sible release are investigated;and 3. amonitoring records are maintained ro 1 . THE FOLLOWING PERSON(S)ARE RESPONSIBLE FOR PERFORMING THE MONITOQUIPMENT MAINTENANCE: 490.73 ;; a ft 490-72. TITLE: 490.75. NAME: ${ , r a,.sTrR� .NAME. 490-74. TITLE: The Designated UST Operator shall perform a monthly visual inspection of the facility,prothe owner/odor,and inform the owner/operator of any conditions that need follow-up action. I. OWNER(OPERATOR SIGNATURE CERTIFICATION:I certify that the i[IFOCIPation provided herein is true and accurate to the best of my knowledge. 490-77 APPLICANT SIGNATURE DATE: REP1.Tank 2.Facili 3.Autlroraedit 've dGmer 490-76. 490-74. 49U-74, APPLICANT TITLE. APPLICANT NAME(print): Owner v "IrtRe A `:� UPCF UST-D(tZ -3/4 www.unidoes.org