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�IFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) VL UNDER DISPENSER CONTAINMENT(UDC)MONITORING 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD - 490-54a ❑ 1.CONTINUOUS ELECTRONIC MONITORING490-54b ®2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE ❑ 4.NO DISPENSERS [199.OTHER(Specify):____________ PANEL MANUFACTURER: 49ass—LMODEL#: ------ 49as6. --- —— ------------'-- LEAK SENSOR MANUFACTURER: 490-50 1 MODEL#(S): 49x58 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 49°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 490L2 2.UDC CONSTRUCTION IS ®1.SINGLE-WALLED ❑2.DOUBLE-WALLED 49040 IF DOUBLE WALLED: 490=s4a UDC INTERSTITIAL SPACE IS MONITORED BY �_I_LIQUID__-(]_2_PRESSURE [13.VACUUM -- A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a.YES ❑b.NO 490-64b - - VIL PERIODIC SYSTEM TESTING ❑ —IELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490-65. ____2._LEAK DETECTION(ELD)MUST BE PERFORMED_ PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REUIRED._L3 CCR¢2644.1)Q ® SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 49 6 ❑MIS BUCKETS ARE TESTED ANNUALLY. 49M7 VIII.RECORDKEEPING The following monitoring/maintenance records are kept for this facility: ®Alarm logs 490 &a ®Visual Inspection Records 490.686 ❑Tank integrity testing results 490b8c ❑SIR testing results(and supporting documentation records). 49MIld ❑ Tank gauging results(and supporting documentation records). 490-60e ❑ATG Testing results(and supporting documentation records).490fi8r ❑ Corrosion Protection 60-day logs 490-68,, ❑Equipment maintenance and calibration records. 490-69h IX.TRAINING ®Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to theirjob duties. 490fi9a REFERENCE DOCUMENTS MAINTAINED AT FACILITYD(Check all that apply) ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)490-69b ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)490-69c ® CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 4% 9d ® CALIFORNIA UNDERGROUND STORAGE TANK LAW 49069. ® STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION"490-69f ® SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"490-69g ❑ OTHER(Specify):m69h M69i LJ 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.490-70 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 M ec-k i ca l F'l ee er 2` /e- 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 person(s)are responsible for performing the monitoring and equipment maintenance: NAME Chacko Thomas 490-72 TITLE owner 490-]3 NAME Linda Martin 490-74 TITLE Manager 490-75 The Designated 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. XIL OWNER/OPERATOR SIGNATURE CERTIFICATION: 1 certify that the information provided herein is true and accurate to the best of my knowledge. APPLICANT GNATURE 490-76 DATE: 490-77 CcC -v 5/3/2011 REPM E 1.TeNc eretor 2.F i it Own r for 3.Authari d Re r e t ri (Owner APPLICANT NAME(print): 490'8 APPLICANT TITLE: 400-79 Linda Martin Manger UPCF UST-D(122007)3/4