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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUNDSTORAGETANK MONITORING PLAN — (Page 2 of 2) VI. UNDER DISPENSER CONTAINMENT (UDC) MONITORING (CheekaQ aiatEeLLv2 UDC MONITORING IS PRFOR MF)USING'fHE FOLLOWING METHOD(S) ❑�,/`.CONTINUOUS ELECTRONIC MONITORING El 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE 490-54. IlQ %.NO DISPENSERS ❑ 99.OTHER(Specify) 490-54b' LEAK MONITOR MANUFACTURER: 490.55- MODEL q: 490.56' LEAK SENSOR MANUFACTURER: ~7. MODEL#(S): 49 58. DETECTION CT A FLAK 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 090'60' FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ❑ b.NO d90'6I' UDC MONITORING STOPS THE FLOW OF PRODUCT AT TI IF DISPENSER. ❑ a YES ❑ b.NO 090-6z. UDC CONSTRUCTION IS: ❑ L SINGLE WALL ❑ 2 DOUBLE WALL 4�62r IF DOUBLE WALL: 490x4. 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 490-60b- VII. PERIODIC SYSTEM TESTING ❑ I.ELD TESTING: THIS FACILITY HAS BEEN N011F'IED 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 133 CCR 42644.11 ® 2. SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTIIS. 490-66. ® 3.SPILL BUCKETS ARE TESTED ANNUALLY. 490-61. VIII. RECORD KEEPING The following monitoring/maintenance records are kept for this facility: 490-69. ® 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 M 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) 490-696. ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) 4%-69c ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490-69e. ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490-6%. ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND 4%-69f STATISTICAL INVENTORY RECONCILIATION" ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 490691 ❑ OTHER(Specify): 490'6q'' 490 6a. This facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council 49o-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[mining 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. D 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 persons)for emergencies and monitoring alarms. X. COMMENTS/ADDITIONAL INFORMATION Provide additional comments here or indicate In many a es with 61 Z.S a itional i formation on specific monitoring procedures are attached to this plan 49-7' o� TAp� XI. PERSONNEL RESPONSIBILITIES The UST Owner/Operator is responsible for ensuring that. 1)the daily/routine UST monitoring activities and maintenance of UST Teak detection equipment covered by this plan occur 2J all conditions that indicate a possible release are investigated;an monitoring intained properly _ s; _,__ )a momtonn records are ma _ THE FOLLOWING P (S)ARE FOR PERFORMING THE MONITORING AN EQUIP N�TENANCE: NAME: �C 49o-n. TITLE:Q , 1 49o.r3. NAME: z 490-74. TITLE: 49x25. 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 1`011ONk-up action. XII. OWNER/OPERATOR SIGNATURE CERTIFICATION: 1 certify that i rmatio vided herein is true and accurate to the best of my knowledge. APPLICANT SIGNATURE DATE: 490-77 /41 MPRESEM GWCi 2.F.flh Owner/ e,.r 3.Auaiori R rcvenu6ve of Owner 490-76. APPLICANT NAME(print): 490.78- APPLICANT TITLE: 690'79 ofd// S-7_;'fGG .,s UPCF UST-D(12/2007)-3/4 www.unidocs.org