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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 1S PERFORMED USING THE FOLLOWING METHOD 490 50-: ® 1.CONTINUOUS ELECTRONIC MONITORING [12.FLOAT AND CHAIN ASSEMBLY [13.ELECTRONIC STAND-ALONE ssr-Sah Q 4.NO DISPENSERS 1399.OIHER(Specify_); --- PANEL MANUFACTURER.Header Root(VR)— ---- 490-65 MODEL#:TLS 35t)R 490-sc. LEAK SENSOR MANUFACTURERVR UDC Interior 490.17 1 MODEL#(S):794380-208 490.58 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ® a.YES ❑b.NO 493.50 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN ® a.YES ❑b.NO 490.60 FAILURE I DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. it.YES ❑b.NO 490-6 UDC MONITORING STOPS THE FLAW OF PRODUCT AT THE DISPENSER. ® a.YES ❑b.NO 49M2 2.UDC CONSTRUCTION IS ®I.SINGLE-WALLED ❑2.DOUBLE-WALLED 49M3 IF DOUBLE WALLED: ago 60-: T UDC INTERSTITIAL SPACE IS MONITORED BY: ❑1-QUID 2.PRESSURE ❑3.VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ®a.YES ❑b.NO a9c rwh VII.PERIODIC SYSTEM TESTING I. ELD TESTING:THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490-65. MUST BE PERFORMED. PERIODIC EL.D IS PERFORMED EVERY 36 MONTHS AS REQUIRED. 23 CCR"2644.1) ®2.SECONDARY_CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 49066 3.SPILL BUCICKI S ARE TESTED ANNUALLY, W — --- 49067 VIII.RECORDKEEPING `Ilse following monitoring/maintenance records are kept for this facility: ®Alarm logs 490.638 19 Visual Inspection Records 490-68b ❑Tank integrity testing results 49a ac ❑SIR testing results(and supporting documentation records). 49068d ❑ Tank gauging results(and supporting documentation records). 49o-68e ATG Testing results(and supporting documentation records).490-68f ❑ Corrosion Protection 60-day logs 490488 ®Equipment maintenance and calibration records. 490-o8h IX.TRAINING Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their jab duties. 49mg5n REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)4so-69b OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)490-69e ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 49tw d ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490-69e ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION"49"9f ❑ SWRCB PUBLICATION:-UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"490-698 ❑ OTTER(Specify):M69h M69i This facility has a"Designated UST Operator'who has passed the CaUfomia 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: i Operation of the UST systems in a maturer consistent with the facility's best management practices • The facility employee's role with regard to the monitoring equipment as specked in this UST Monitoring Plan Y The facility employee's role with regard to spills and overfills as specific!in the UST Response Plan > Names of contact person(s)for emergencies and monitoring alarms.490.70 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.490-71 XI.PERSONNEL RESPONSIBILITIES The UST Owner/Operator is responsible for ensuring that:l)the daily/routine UST monitoring activities and maintenance of UST leak detection equipment coveted by this plan occurs,2)all conditions that indicate a possible release are investigated.and 3)all monitoring records are maintained Property. The following person(s)are responsible for performing the monitoring and equipment maintenance: NAME _ 49o.72 TITLE 490-73 NAME 49[-74 TITLE 490-75 The Designated Operator shall petfotm a monthly visual inspection of the facility,provide a report to the owner/operator.and inform tete ownerloperator 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 bast of my knowledge. APPLICANTSIGNATU 49¢76 DATE: 4r40-77 Oct 3,2009 f APPLICAN 'DAME(print): 440.78 APPLICANT TITLE: 490-79 Dennis Dock Compliance Manager UPCF UST-D(12!2007)314