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UNfMD PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN- (Page 2 of 2 VI. UNDER DISPENSER CONTAINMENT DC MONITORING at 0-p al (UDC) hat a r UDC MONITORING IS PERFORMED USING THE FOLLOWING Iv ETHOD(S) ® 1.CONTINUOUS ELECTRONIC MONITORING ❑ 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE 490-54& ❑ 4.NO DISPENSERS ❑ 99.OTHER(Specify) 490.54b. LEAK MONITOR MANUFACTURER:Veeder Root 490-55. MODEL#:TLS 350 490-56. LEAK SENSOR MANUFACTURER:Veeder Root 490-57 MODEL 0-(s):794380-208 490-58. DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. Ea.YES ❑ b.NO 490-59- UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ® a.YES ❑ b.NO 490- 60-FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. E a.YES ❑ b.NO 490.61. UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. ® a.YES ❑ b.NO 490.62. UDC CONSTRUCTION IS: ® 1.SINGLE WALL ❑ 2.DOUBLE WALL 490.63• IF DOUBLE WALL: 490-64& 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 490-46 VII. PERIODIC SYSTEM TESTING rl I.ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490-65• LEAK DETECTION BLD)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. 490-67. VIII. RECORD KEEPING The following monitoring/maintenance records are kept for this facility: 49x68• ® 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 sup)Sorting documentation records) ❑ f.ATG TESTING RESULTS(and supporting documentation records) ❑ g.CORROSION PROTECTION 60-DAY LOGS ® h.EQUIPMENT MAINTENANCE AND CALIBRATION RECORDS IX. TRAINING Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to eir job duties: 490-69a. REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) ^ t 490.69b. ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) I 490.69c. ® CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 49a69d• ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 4969e. ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: BOOK FOR TANK OWNERS - MANUAL AND 490.691: STATISTICAL INVENTORY RECONCILIATION" ® SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING STEMS" 490-698. ❑ OTHER(Specify): 490ago-.69i. 691. ® This facility has a"Designated UST Operator"who has passed the California T System Operator Exam administered by the International Code Council 490-70. (ICC). The "Designated UST Operator"will train facility employees in the oper 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 fai*'lit, s best management practices. Y The facility employee's role with regard to the monitoring equi t as specified in this UST Monitoring Plan. The facility employee's role with regard to spills and overfills a ified in the facility's UST Response Plan. ➢ Name(s)of contact person(s)for emergencies and monitoring glarms. X. COMMENTS/ADDITIONAL INFORMATION Provide additional comments here or indicate how many pag with additional information on specific monitoring procedures are attached to this plan. 490.71• PERSONNEL RESPONSIBILITIES The UST Owner/Operator is responsible for ens ' that: 1.)the daily/routine UST monitoring activities and maintenance of UST leak detection equipment covered by this plan occurs;2.)all conditions that indicate possible releaseare investigated;and 3.)all monitoring records are maintained properly. THE FOLLOWING PERSON(S)ARE RES SIBLE FOR PERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE: NAME: 490-72. TITLE: 490-73. NAME: 490.74. TITLE: 490-75. The Designated UST Operator shallrform 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 acti XII. OWNER/OPERATOR SIGNATURE CERTIFICATION:I certify that the information provided herein is true and accurate to the best of my knowledge. APPLICANT SIGNATURE DATE: 490-77. REPRESENTING:[11.Tank Owner/ for[12.Facili Owner/Operator ❑3.Authorized Rqnywwative of owner 490-76. APPLICANT NAME(print): 490.78. APPLICANT TITLE: 49x79. Lal Jojinder Operator/ Owner UPCFUST-D(12/200')-3/4 ;� tic wwtv.unidocs.org � `7 t 01 261 ley