BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

i UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORINCPLAN (Page2of2) VI. UNDER DISPENSER CONTAINMENT(UDC)MONITORING I. LDC'MONITORING IS PERFORMED USING'F F OLLOWING METHOD 4911-`4' ,)u-4b ❑ I.CONTINl10l1S ELECTRONIC MONIT'ORING2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE i-NO_DISPf_NSERS099.-OTHER(Specify)-------------"--- --------___._______- _. ..____- ,.____-_.. PANEL MANUFACTURER: 4�1"" , MODEL R: +"0-56 LEAK SENSOR MANUFACTURER" 4011'57 ! MODEL H(S): - "---------------"-_--_" ---" --"- +`lssx DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑ a.YES ❑b.NO 4°111 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN ❑ a.YES ❑b.NO 4'11)4,11 FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. [:] a YES ❑b.NO 40161 UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. ❑ a.YES ❑b.NO 4'X1"r.2 2.UDC CONSTRUCTION IS ❑l.SINGLE-WALLED ❑2 DOUBLE-WALLED J00-" IF DOUBLE.WALLED: - -UDC INTERSTITIAL SPACE IS MONITORED BY: 0-1,-LIQUID_[1 2_PRESSUREE1 3,VACUUM - _-____ A LEAK WHIIIN THE SECONDARY CONTAINMENTOF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a YES ❑b NO 4`Xr4'46 VII.PERIODIC SYSTEM TESTING — --- — --- -- — ❑ I. ELU"TESTING: THIS—FACILITY HAS BEEN NOTIFIED RY THE STATE WATER RESOURCES C'ONT'ROL. BOARD'1'HA'1' ENHANCED 4'r115 _ L.AK DETECTION ELU MUST'BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRE?. 23 CCR 2641 1 f ❑2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS 4'X14,6 L❑3_SPILL BUCKETS ARE TESTED ANNUALLY. ----------------- „90.6, VIII.RECORDKEEPING The following monitoring/maintenance records are kept for this facility: Alarm Ings 4'+14,x,, $Visual Inspection Records 4w1-61b ❑Tank integrity testing results 4�m-6ac ❑SIR testing results(and Supporting documentation records). +,)1)-6sd ❑ Tank gauging results(and supporting documentation records). 41X1.6xe ❑ATG Testing results(and supporting documentation records).4'X1.65' ❑ Corrosion Protection 60-day logs 4�m-68y ❑Equipment maintenance and calibration records. 4'Xu,xh IX.TRAINING Personnel with US-T monitoring responsibilities are familiar with all ofthe following documents relevant to their lob duties. rm-61, REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) f�THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)4ro"<,ro .OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)+,)u.6oc CALIFORNIA 11NDL"-RGROUND S"I'ORAGE TANK REGULATIONS+n1-o-w CALIFORNIA UNDERGROl/ND STORAGE TANK LAW rX*roe STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION"rX.aOr S W RCB PUBLICATION:"UNDERSTANDING AUl'OMATIC TANK GAUGING SYSTEMS"+ml-tos ❑ O"TITER(Specify):N161h M691 This facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council(ICC). "rhe"Designated UST Operator”will train facility employees in the proper operation and maintenance of the UST systems annually,and within 30 days of hire.'I"his training will include,but is not limited to,the following: e Operation of the LIST systems in a manner consistent with the facility's best management practices Y The facility employee's role with regard to the monitoring equipment as specified in this UST Monitoring Plan i The facility employee's role with regard to spills and overfills as specified in the UST Response Plan Names ofcontact pers6rus)for emergencies and monitoring alarms.4,)11.71) X. COMMENTS/ADDITIONAL INFORMATION Provide additional comments here ar indicate how mamv pages with additional information on specific monitoring procedures are attached to this plan.44x-7 XI.PERSONNEL RESPONSIBILITIES [Uhe__U_S10w,ner/Operator is responsible for ensuring that: ])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, llie follm..,,, r,un(s)are res�nyor,.0/J1)w 1��aertbb in he monitoring and equipment maintenance Ni AME oham K U VQ 1 G(Q 12- 4rUn TITLE +,m-73 NAME P_ 400-7+ TITLE 1'X171 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 WNER/OPERATOR SIGNATURE CF:RTIF' .ATION:I rti�. hat the inti natio r v' d he m 1)d accurate to the best of my knowledge. (Yy IC N'T SIGNA" E 410-m DATE_ 401).77 n rsevN . 1 7.N 11e;o r r F.01, er1 _I s,�m��..d,,ere 1ti,eor Nne1 C/' 11✓Iloq APPLICANT NAME(print . J00-7x APPLICANT TI"TLE: 4'X1'7' a MQ S to ner L P('F(S'1'-D(12/2007)314