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001906 UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN — age 2 of 2) VI. UNDER DISPENSER CONTAINMENT (UDQ MONITORING (Check all that apply UD ONITORING 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 _........---.._....-----..-.__.._._.,_.._..__.._._____._____.__ ❑T�99.OTHER Specify) 490-54b. LEAK MONITOR MANUFACTURER: V t { C�t.f 490-55. MODEL #: L 5' 49&56. LEAK SENSOR MANUFACTURER: C QpGi 490-57• MODEL #(S): - ZO 490-5s. DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. a.�YES El b. NO 490.59, ,�,�/ UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ? YES ❑ b. NO 490-0- FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. YES ❑ b. NO UDC 49MI. 490-62• MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. YES ❑ b. NO _ .... - . .. .... UDC CONSTRUCTION IS. ❑ 1. SINGLE WALL 2. DOUBLE WALL 49"3 IF DOUBLE WALL.490.64L UDC INTERSTITIAL SPACE IS MONITORED BY: a. LIQUID ❑ b. PRESSURE [3 ,/VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. F a. YES ❑ b. NO 490-64b. VII. PERIODIC SYSTEM TESTING ❑ 1. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490-6 _ LEA MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. 123 CCR §2644. 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/maintet nce records are kept for this facility: 490.68. ® a. ALARM LOGS (� b. VISUAL INSPECTION RECORDS ❑ c. TANK INTEGRITY TESTING RESULTS ❑SIR TESTING RESULTS (and supporting documentation records) [Ie. TANK GAUGING RESULTS (and supporting documentation records) Q 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 to theirjob duties: 490-69& REFERENCE DOCUMENTS MAINTAINED AT FACILITY (Check all that apply) ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN (Required) 490.69b. ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT (Required) 490.69& ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490-69d. ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490.69& ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS MANUAL AND 490.69f. STATISTICAL INVENTORY RECONCILIATION" ❑ SWRCB PUBLICATION: "UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 490698 ❑ OTHER (Specify): 490.69h. This facility has a "Designated UST Operator" who has passed the California UST System Operator Exam administered by the International Code Council 490-69L 490-70. (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. ➢ Name(s) of contact person(s) for emergencies and monitoring alarms. X. COMMENTS/ADDITIONAL INFORMATION Provide addici` 'i cumn:enis here or indicate how many pa .ei whir additional n:ormation on speci - mo. icor g pr ced reS are(a[(aehe0 LO Li17is Pian.71 fti�� J( t)� 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 thisplan occurs; 2.1all conditions that indicate a possible release are investigated; and 3.) all monitoring records are maintained properly. THE FOLLOWING PERSON(S) ARE R/E��SPONSI LE FOR THE MONITORING EQUIPMENT MAINTENANCE: --iiPERFORMING NAME:'jMM Mdtna SChne w� C?rovp �tA1G 490-72 -CD 90 n. TITLE: �01� � ha,ltr 490-73. NAME: 490-74. TITLE: a 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 certif that the information provided herein is true and accurate to the best of my knowledge. APPLICANT SIGNATURE _ _oe� DATE: 490-77. REPRESENTING: [11. lank Ownu/O rnror 2. Facili Owna/0 efator . Authorized R rwentative of Ownar 490-76. 490.78. APPLICANT NAME (print): � � APPLICANTITLE:� 490-79 UPCF UST -D (12/2007) 3/4 www.tinidocs.org