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C IED PROGRAM CONSOLIDATED FORM '*a/UNDERGROUND STORAGE TANK \/ MONITORING PLAN (Page 2 of 2) VL UNDER DISPENSER CONTAINMENT UDC MONITORING 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD I.S0 ❑ 1.CONTINUOUS ELECTRONIC MONITORING 02.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELEC`T'RONIC STAND-ALONE ❑4.NO DISPENSERS ❑99.OTHER(Specify): .PANEL MANUFACTURER: — 49.55 MODEL N: 49.56 LEAK SENSOR MANUFACTURER: Mechanical 49.51 MODEL HIS): 49.56 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 990'60 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 4906¢ 2.UDC CONSTRUCTION IS ISI 1.SINGLE-WALLED ❑ 2.DOUBLE-WALLED 490,63 IF DOUBLE WALLED: UDC INTERSTITIAL SPACE IS MONITORED BY_O OI.LIQUID ❑2.PRESSURE E13_VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDCTRIGGERS AUDIBLE AND VISUAL ALARMS ❑a.YES ❑b.NO 490-64b VII.PERIODIC SYSTEM TESTING 1. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490'65 A_DE CTION E D MUST BE PERFORMED. PERIODIC ELD IS PERFORMED_EVERY_36 MONTHS AS REQUIRED.(23 CCRJ2644_Ij ®2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS 49066 3.SPILL BUCKETS ARE TESTED ANNUALLY, _ 49041 VIII.RECORDKEEPING The following monitoring/maintenance records arc kept for this facility: ®Alarm logs 4sosto ❑Visual Inspection Records 4.68b ❑Tank integrity testing results 4so.6s. ❑SIR testing mutts(and supporting documentation records). 49MIld ❑ Tank gauging mutts(and supporting documentation records). 490-664 ❑ATG Testing results(and supporting documentation records).490661' ❑ Corrosion Protection 60-day logs 490-689 ®Equipment maintenance and calibration records. 490s6h IX TRAINING Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to theirjob duties. 490 6% REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)490696 ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)490.69c ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490-69d ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490o-6% ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION"49a69r ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"4s.69, OTHER(Specify):atash.main 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 D The facility employee's role with regard to the monitoring equipment ha 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 person(s)for emergencies and monitoring alarms.490-10 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.49.11 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 leek detection equipment covered by this plan occurs,2)all conditions that indicate,a possible release aro investigated,and 3)all monitoring records are maintained properly. The following person(s)areresponsible for performing the monitoring and equipment maintenance. NAME Service Contact Center 49o.n TITLE 24 Hours 490-13 NAME Rudy Tover 49014 TITLE Market Manager 49.75 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. XII.OWNER/OPERATOR SIGNATURE CERTIFICATION:I certify that the information provided herein is true and accurate to the best of my knowledge. AP 1CAN SIGN#/pTURE �//,f�.. 49N76DATE: ^9.11 APPLICANT NAME(print): 48016 APPLICANT TITLE: 490-79 Rex T. Abacan Environmental Compliance Manager for Circle K Stores Inc. UPCF UST-D(1212007)2148