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9 UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN - (Page 2 of 2) VI. UNDER DISPENSER CONTAINMENT (UDC} MONITORING (Check all UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) that [v� L CONTIM)OUS ELECTRONIC MONITORING ❑ 2. FLOAT AND CHAIN ASSEMBLY❑ ❑ 3• ELECTRONIC STAND-ALONE 49o -54a. 4_NO DISPENSERS _-_ ❑ 99. OTHER (Specify) 490-91n. LEAK MONITOR MANUFACTURER: Veeder Root 49ass. MODEL M: TLS -350R 4156. LEAK SENSOR MANUFACTURER: Ve dRoot-, 490-57. MODEL#(S): 794380-208 49058. DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. 9 a. YES ❑ b. NO 4119. UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN. Ef a. YES ❑ IS, NO 49160. FAILUREIDISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. Era. YES ❑ b. NO 4vo-s' UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. L•d a. YES ❑ b. NO 4161 UDC CONSTRUCTION IS: Rr 1. SINGLE WALL ❑ 2. DOUBLE WALL 45063. IF ]2!2LIBLE WALL: - .,v UDC INTERSTITIAL SPACE IS MONITORED BY: ❑ a. LIQUID ❑ b. PRESSURE ❑ C. VACUUM 4o- .. A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. Z a. YES ❑ b. NO 41&4b. ERIODIC SYSTEM TESTING TING: THIS FACILIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 4vos5.ET CTI N ELD MUPERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS RE UIRED. I23CCR 2644.1ARY MBEENNOTIFIED CONTAINMENE TESTED EVERY 36 MONTHS. M 4166. CKETS ARE TESTE 490.67III. RECORD KEEPI G.. onitoring/maintenance records are kept for this facility: LOGS ❑ b. VISUAL INSPECTION RECORDS ❑ c. TANK INTEGRITY TESTING RESULTS 490. 8. ❑ d. SIR TESTING RESULTS (and supporting documentation records) ❑ e. TANK GAUGING RESULTS (and supporting 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 thenjob dunes REFERENCE DOCUMENTS MAINTAINED AT FACILITY (Check all that apply) 090-690 ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN (Required) ® OPERATING MANUALS FOR ELECTRONIC MONITORING a9�9b EQUIPMENT (Required) ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 499 c. ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 49G -69'i ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND 0969e 4WOf STATISTICAL INVENTORY RECONCILIATION' ❑ SWRCB PUBLICATION: "UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 4169s, ❑ OTHER (Specify): 490-69h. This facility has a UST Operator" who has the UST System Operator Esam administered by the Imemational Code Council 490 69. 4170. (ICC). "Designated The "Designated UST Operator" will thin filed tysmplo "m es in the in the proper operation and maintenance of the UST systems annually, and within 30 days o days of hire. This training will include, but is not limited to, the following: llo D Operation of the UST systems ins 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. i The facility employee's role with regard to spills and overfills as specified in the facility's UST Response Plan. ➢ Name(s) of contact person(s) for emergencies and monitoring alarms. 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. 49x71. "EDER-ROOT #794380-323 SENSOR AT VENT TRANSITION SDMP. Overfill Prevention Method: External and/vis alarm Set G saw tank capacity XL PERSONNEL RESPONSIBILITIES The UST Owner/Operator is responsible for ensuring that: 1.) the daily/routine UST monitoring activities and maintenance of UST leak detection equit covered by this plan occuro1-ILa11 conditions that indicate a possible release are investigated; and 3.1 all moniI ring_records are maintained pr�rly. THE FOLLOWING PERSON(S) ARE RESPONSIBLE FOR PERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE: NAME: Dennis Bock 'In. TITLE: Environmental Compliance Manager 4173. NAME: Tim Hurlocker 4W74. TITLE: Director of Gasoline o erations 09005. The Designated UST 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 lbilow-up action. XII. O WNER/OPERATOR SIGNATURE' CERTIFICATION: 1 certify that the information provided herein is true and accurate to the best of my knowledge. APPLICANT SIGNATURE �> DATE: 417. w�0 t7 r/ RF.PRESENTn1G:[31. Ta GWnu/O nwr 2. Peeaa Oxa<r/ nr 3. AuWwized rexwuro of Owner 4176. APPLICANT NAME (print): Dennis Bock 49078, APPLICANT TITLE: 4%-79 Environmental Compliance Manager UPCF UST -TJ (tz/lUU7) - 3/4 "" www,uoidocs.org