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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 490-54a [__11.CONTINUOUS ELECTRONIC MONITORING W 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE 41M-54b ❑4.NO DISPENSERS ❑99.OTHER(Specify): -- --- ------------------ -- ----------------------------------------------------------- - PANEL MANUFACTURER: ��—� 4x1-55 MODEL#: 490.56. ------------- ----------- - --- ------------ ------------------------------------- LEAK SENSOR MANUFACTURER: 490-57 MODEL#(S): _ 490-58 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑ a.YES [J�tf.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. ❑ a.YES qtr NO 490-61 UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. GI-r. 4ES ❑b.NO 41X1-62 2.UDC CONSTRUCTION IS [SINGLE-WALLED ❑2.DOUBLE-WALLED 490-63 IF DOUBLE WALLED: 490--64a — —UDC INTERSTITIAL SPACE IS MONITORED BY: Q 1.LIQUID ❑2.PRESSURE ❑3.VACUUM --- - - - ------------------- A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS 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 41M-65. __________LEAK DETECTION(ELD)MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED.X23 C(;R§2644.1) SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490-66 --- - --- ------T—E -------------------------------------------- ------------------------- ------------ .SPILL L BUCCKKETS ARE TESSTED ANNUALLY. 490-67 VIII.RECORDKEEPING The following monitoring/maintenance records are kept for this facility: VASIlarm logs 41,X1.68. ElVisual Inspection Records 490-68b (Tank integrity testing results 490-68c R testing results(and supporting documentation records). 4x)-68d ❑ Tank gauging results(and supporting documentation records). 490-68e ❑ATG Testing results(and supporting documentation records).49(>-68f ❑ Corrosion Protection 60-day logs 491-68g [;Kq-uipment maintenance and calibration records. 41X1-68h IX.TRAINING ersonnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 490-69a REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) r�HIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)4x1.696 I? DPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)490-69c O. CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 4x1.69d LIFORNIA UNDERGROUND STORAGE TANK LAW 490-69e STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION"490-69f ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"49(1-69g ❑ OTHER(Specify):M69h.M69i is facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council(ICC). T e"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: Y 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 person(s)for emergencies and monitoring alarms.49(1-70 X. COMMENTS/ADDITIONAL INFORMATION Provide additional comments here or indicate how man pages with additional information on specific mono ring procedure re attached to this plan.490-71 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 this plan occurs,2)all conditions that indicate a possible release are investigated,and 3)all monitoring records are maintained properly. The follow erson(s)a e res onsib a for performing the monitoring and equipment maintenance. NAME 490.72 TITLE 490-73 NAME 49-74 TITLE 490-75 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. APPLICANT SIGNATURE YC/ ^ 491-76 DATE: 490a7 r REPRESENTING: I.Tanv�A 0,ner/O [71 Facihis O,ner.'O erator M 3 AWhorved Re resentime or Oaner ' APPLICANT NAME(print): n> W 490-7% APPLICANT TITLE: / 490.79 /� S7 UPCF l QST-D(12/2007)3/4