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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUNDSTORAGETANK MONITORINGPLAN (Page2of2) VI.UNDER DISPENSER CONTAINMENT(UDC)MONITORING 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD - 4m-54a ❑ I.CONTINUOUS ELECTRONIC MONITORING4w-54b ❑2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE ❑ 4.NO DISPENSERS ❑99.OTHER(Specify): PANEL MANUFACTURER: 49°"55 MODEL LEAK SENSOR MANUFACTURER: 490"sr MODEL#(S): 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 POMP SHUTDOWN ❑ a.YES ❑b.NO 49070- 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 40-]72 2.UDC CONSTRUCTION IS [:]I.SINGLE-WALLED ❑2.DOUBLE-WALLED 49463 IF DOUBLE WALLED: "0-96=cos UDC INTERSTITIAL SPACE IS MONITORED BY_ 1.LI UID 2. A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a.YES ❑b.NO 490746 VII.PERIODIC SYSTEM TESTING ❑ I. EL D TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 49075 LEAK DETECTION(ELS MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. 2 CCR 2644.1)_ _ ❑2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490-00 ❑3.SPILL BUCKETS ARE TESTED ANNUALLY. 490-6] VIII.RECORDKEEPING The following monitoring/maintenance records are kept for this facility: Alarm logs 49078a $Visual Inspection Records 49 68b ❑Tank integrity testing results 49 6& ❑SIR testing results(and supporting documentation records). 490-6ed ❑ Tank gauging results(and supporting documentation records). 490-68e ❑ATG Testing results(and supporting documentation records).490781 ❑ Corrosion Protection 60-day logs 4W-68g ❑Equipment maintenance and calibration records. 4no.68h IX.TRAINING Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to theiriob duties. 490-69a REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) f[Y THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)490-69b ,OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)490.690- CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 49 69d 16 CALIFORNIA UNDERGROUND STORAGE TANK LAW 490.69e STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION"490-.691 Zr SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"4%-69g ❑ OTHER(Specify):M691.MA 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: D 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 D Names of contact persb t(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 XL 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 foil g person(s)are respo for�performin he monitoring and equipment maintenance. NAME \ 490-n TITLE 490-03 NAME Q_ 0-90-]4 TITLE 4Stl-]5 The Designated Operator shall perform a monthly visual inspection of the facility, provide a report Id the owner/operator, and inform the owner/operator of any conditions that need follow-up action. XII.OWNER/OPERATOR SIGNATURE CERTIFICATION:I ify that the informatio erein is true and accurate to the best of my knowledge. X� CANT N T 490-76 DATE. �•YaI(, /�J/��1� 49o-77 ES k — /O R , / whanxedR nl iveaf u APPLICANT NAME(print. 490-78 APPLICANT TITLE: 490-]9 Was Mzmer UPCF UST-D(122007)314