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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN - (Page 2 of 2) V1. UNDER DISPENSER CONTAINMENT (UDC) MONITORING (Check au that apply) UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) ® 1. CONTINUOUS ELECTRONIC MONITORING ❑ 2. FLOAT AND CHAIN ASSEMBLY ❑ 3. ELECTRONIC STAND-ALONE 490-54a. 4. NO DISPENSERS 99.OTHER S eci _.._..._.-.....-...-------_ ..__-_._._�P__�_...._.---...._.___....._ 490-54b. _......__...._ LEAK MONITOR MANUFACTURER: Veeder-Root 190-55. MODEL #: TLS -350 490.56. LEAK SENSOR MANUFACTURER: Veeder-Root 190-17. MODEL #(S): 208 / 304 490.58. DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ® a. YES ❑ b. NO 490-59. UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ® a. YES ❑ b. NO 490-60. FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ® a. YES ❑ b. NO 490.61. UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. ® a. YES ❑ b. NO 49"2 - _ UDC CONSTRUCTION IS: ❑ 1. SINGLE WALL ® 2. DOUBLE WALL 490 -6i - IF DOUBLE WALL: 490-64a. UDC INTERSTITIAL SPACE IS MONITORED BY: ® a. LIQUID ❑ b. PRESSURE ❑ c. VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ® a.YES ❑ b.NO 490-64b. VII. PERIODIC SYSTEM TESTING ❑ I. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490-65. LEAK DETECTION ELD MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. 123 CCR 82644.11 ❑ 2. SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490-66. ® 3. SPILL BUCKETS ARE TESTED ANNUALLY. 490-67 VIII. RECORD KEEPING The following monitoring/maintenance records are kept for this facility: 490-6x. ® a. ALARM LOGS ❑ b. VISUAL INSPECTION RECORDS ❑ c. TANK INTEGRITY TESTING RESULTS ❑ d. SIR TESTING RESULTS (and supporting documentation records) ❑ e. TANK GAUGING RESULTS (and supporting documentation records) ❑ f ATG TESTING RESULTS (and supporting documentation records) ❑ g. CORROSION PROTECTION 60 -DAY LOGS ® h. EQUIPMENT MAINTENANCE AND CALIBRATION RECORDS IX. TRAINING ® Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant totifdtatles ' REFERENCE DOCUMENTS MAINTAINED AT FACILITY D (Check all that apply) h_ 490-69b. ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN (Required) 490-69c ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT (Required) p 2011 490-69d. ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS Ap R 3 490-69e ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490-69f ` C LTM ❑ OTHER (Specify): y�N JO," • %. ' 490.69h. 490-69i. ® This facility has a "Designated UST Operator" who has passed the California UST System Operator Exam admin�1thrr pterin Code 490-70. Council (ICC). The "Designated UST Operator" will train facility employees in the proper operation and maintenance oil t T 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. ➢ Name(s) of contact person(s) for emergencies and monitoring alarms. 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. 490.71. UST Turbine (STP), Fill, UDC's & Vent Sumps Monitored by Veeder Root Brine Sensors 304 and liquid sensors 208. Product & Vapor lines Monitored with Veeder Root Vacuum Smart Sensors. Automatic tank gauging (ATG) system used to monitor double wall tanks with In tank probe Veeder Root Magt. Overfill prevention method: External Audible Visual Alarm set at 90% of tank capacity. EVR ISD software installed. 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 3J. all monitoring records are maintaine42r2perly.-� - THE FOLLOWING PERSON(S) ARE RESPONSIBLE FOR PERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE: NAME: Rosella Biggs 490-72• TITLE: Manager 490-73, NAME: Shrell Belton 490-74 TITLE: Asst. Manager 490-75, 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 conditions that need follow-up action. XII. OWNER/OPERATOR SIGNATURE CERTIFICATION: I certify that the information provided herein is true and accurate to the best of my knowledge. APPLICANT SIGNATURE )DATE: 490-77 �.` 04/29/2011 REPRESENTING: N I. Tank Owner/Operator 2. Facility Owner/Operator 3. Authorized Representative of Owner 490-76. APPLICANT NAME (print): 490-78. APPLICANT TITLE: 490-79' Chevron Products Co./ Chevron Retail HES Permit Desi: (Agency use only) his j nt 'ewed and: ApprovaTE�J' Local Agency Signature: /: Comment, or SpecNi Condi Approved with Conditions❑ Disapproved❑ Date: Q -1-1 .