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l 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 ❑ 1.CONTINUOUS ELECTRONIC MONITORING ra 2.FLOAT AND CHAIN ASSEMBLY El 3.ELECTRONIC STAND-ALONE 490-54b❑4.NO DISPENSERS 099.OTHER(S ify): r PANEL MANUFACTURER: F(.�✓a-- 490-55 MODEL#--------------- -- 490.56. LEAK SENSOR MANUFACTURER: 490 57 MODEL#(S): — 49ass DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑ a.YES CR:tf.NO 490-59 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN 93-a.YES ❑b.NO 490-60. FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES Q-*NO 490-61 UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. G].etYES ❑b.NO 490-62 2.UDC CONSTRUCTION IS [SINGLE-WALLED ❑2.DOUBLE-WALLED 490-63 IF DOUBLE WALLED: 490-64a UDC INTERSTITIAL SPACE IS MONITORED BY: ❑ 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 490-65. EAK DETECTION ELD MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. 23 CCR 2644.1 21.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490-66 SPILL BUCKETS ARE TESTED ANNUALLY. 49o.67 VIII.RECORDKEEPING The following monitoring/maintenance records are kept for this facility: larm logs 49"& ❑Visual Inspection Records 490.68b EJ*Tnnk integrity testing results 490-68c Lj SIR testing results(and supporting documentation records). 490-69d ❑ Tank gauging results(and supporting documentation records). 490-68e ❑ATG Testing results(and supporting documentation records).49o-68f ❑ Corrosion Protection 60-day logs 49o-68g uipment maintenance and calibration records. 490-6ah IX.TRAINING ersonnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 49069a REFEUNCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) Ra-MIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)490-69b [?OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)49"9c O'CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 49o-69d 92�IFORNIA UNDERGROUND STORAGE TANK LAW 49"% 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"490-69g ❑ OTHER(Specify):M69h•M69; ERAis facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council(ICC). 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: > 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.490-70 X. COMMENTS/ADDITIONAL INFORMATION Provide additional comments here or indicate how man pages with additional information on specific mom nng procedur a attached to this plan.490-71 6LW I` XII.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 folio rson(s)a e res nsib a for performing the monitoring and equipment maintenance: NAME 490-72 TITLE 490-73 NAME 490.74 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.OWNERIOPERATOR SIGNATURE CERTIFICATION:I certify that the information provided herein is true and accurate to the best of my knowledge. APPLICANT SIGNATURE Q 490-76 DATE: 490-77 ( - (g- P l 0,, /Q. 2 rh ,n ! r 3.Authonzed Re atic f , APPLICANT NAME(print): /:/� � 49040- APPLICANT T� 490-79 UPCF UST-D(12/2007)3/4