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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) VI. UNDER DISPENSER CONTAINMENT(UDC)MONITORING 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 49o-54. ago ob 1.CONTINUOUS ELECTRONIC MONITORING [12.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE ❑4.NO DISPENSERS ❑99.OTHERS i PANEL MANUFACTURER- LEAK ANUFACTURERS�__ 49o-s6. LEAK SENSOR MANUFACTURER: 6C� _ j 4905') MODEL#(S): Po 49018 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS 99 a.YES ❑b.NO 4so-59 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN IN a.YES ❑b.NO 49 FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. IF a.YES ❑b.NO 49pb1 UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER 19a.YES ❑b.NO 49062 2.UDC CONSTRUCTION IS RUL SINGLE-WALLED ❑2.DOUBLE-WALLED 490.61 IF DOUBLE WALLED: 490648 UDC INTERSTITIAL SPACE IS MONITORED BY Q I LI UID 112.PRESSURE ❑3.VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a.YES ❑b.NO 490-646 VII.PERIODIC SYSTEM TESTING ❑ I. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490-6s. LEAK DETECTION ELD MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED.(23 CCR§2644.1) ❑2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490-66 ❑3.SPILL BUCKETS ARE TESTED ANNUALLY. -49u67 VIII.RECORDKEEPING The following monitoring/maintenance records are kept for this facility: Alarm logs 490-68a Visual Inspection Records 490-686 .�3-t+�Tank integrity testing results 49oesc SIR testing results(and Visual documentation recorcls). 490aaa _ Tank gauging results(and supporting documentation records). 49o.68e ATG Testing results(and supporting documentation records).4% Sf ❑ Corrosion Protection 60-day logs 49o-6&g Equipment maintenance and calibration records. 490686 IX.TRAINING Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to theirjob duties. 4"49a REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)49 % OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)4669[ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 49069a CALIFORNIA UNDERGROUND STORAGE TANK LAW 4o STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION"4ofi9r ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"490698 ❑ OTHER(Specify):M69h,M6% 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 ➢ 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 ➢ Names of contact persons)for emergencies and monitoring alarms.49070 X. COMMENTS/ADDITIONAL INFORMATION Provide additional comments here or indicate haw many pages with additional information on specific monitoring procedures are attached to this plan.4907i o ti ii `moi w�ac - 9� XI.PERSONNEL E PONSgLITIES 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 dition icate a possible release are investigated,and 3)all monitoring records are maintained properly. The following 1 r performing the monitoring and equipment maim nce. NAME 4w-72 TITLE y 49041 NAME f C-4— 490.04 TITLE 49an 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. OWNEWOPERATOR SIGNATURE CERTIFICATION:I certify orm on geU4clecl herein is true and accurate to the best of my knowledge. APPLICANT SIGNATURE 4%-96 DATE: 4967 fL -y-'� MtI=ANTNAME(print): °90']8 APPLICANT TITLE: UPCF UST-D(12/2007)3/4