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NIFIED 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 490.50 490.64b ❑ 1.CONTINUOUS ELECTRONIC MONITORING 02.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE ❑4.NO DISPENSERS ❑99.OTHER PANEL MANUFACTURER: 49°-99 MODEL#: 491-56. LEAK SENSOR MANUFACTURER: Mechanical 49F6] MODEL#(S): 490.51 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS N a.YES ❑b.NO 490-39 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN N a.YES ❑b.NO 490.60 FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SI IUTDOWN. N n.YES ❑b.NO 490.61 UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. N a.YES ❑b.NO 490.62 2.UDC CONSTRUCTION IS ® 1.SINGLE-WALLED ❑ 2.DOUBLE-WALLED 490-68 IF DOUBLE WALLED: UDC INTERSTITIAL SPACE IS MONITORED BY: El 1.LIQUID 0 2_PRESSURE 03_VACUUM________ _ A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a.YES ❑b.NO 490-696 VII.PERIODIC SYSTEM TESTING El L ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY 'rHE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 4-6 LEAK DETECTIONfEI.D)MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED.(23 CCR✓f26444 _ ®2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 49°66 3.SPILL BUCKET'S ARE TESTED ANNUALLY. 490.67 VIII.RECORDKEEPING Tire following monitcring/maintenance records are kept for this facility: N Alarm logs 44081. ❑Visual Inspection Records 49a68b ❑Tank integrity testing results 490-6a. ❑SIR testing results(and supporting documentation records). 49MU ❑ Tank gauging results(and supporting documentation records). 490--6e. ❑ATG Testing results(and supporting documentation records).4mur ❑ Corrosion Protection 60-day logs 490-688 N Equipment maintenance and calibration retards. 44o6eu IX.TRAINING Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to lheirjob duties. 490694 REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) N THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)4906% N OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)49"% ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS4WM ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490.69. ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION"491-690 ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"490698 ❑ OTHER S eci :m69n,m6w N 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 D The facility employee's role with regard to the monitoring equipment as specified in this UST Monitoring Plan D The facility employee's role with regard to spills and overfills as specified in the UST Response Plan D Names of contact persoMs)for emergencies and monitoring alarms.4L70 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.4W71 Flapper Valve _ 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 Oris plan occurs,2)all cundilions 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 Service Contact Center 990-72 TITLE 24 Hours 49073 NAME Rudy Tover 49x74 TITLE Market Manager 490-75 The Designated Operator shall perform a monthly visual inspection of the facility,provide a report in the oww/operator,and inform The owner/operator of any conditions that need follow-up action. XII.OWNERIOPERATOR SIGNATURE CERTIFICATION:I certify that the information provided herein is Ime and accurate to the best of my knowledge. APJILICANISIGNyTURE 490-76 DATE: °90-77 I � 1w Caw Lc �� P,;bVSr 13 2.»9 APPLICANT NAME(print): 4W72 APPLICANT TITLE: 490-79 Rex T.Abacan Environmental Compliance Manager for Circle K Stores Inc. UPCF UST-D(12/2007)2/48