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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN— (Page 2 of 2) VI. UNDER DISPENSER CONTAINMENT (UDC) MONITORING (Checkall that apply) UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) ❑ I.CONTINUOUS ELECTRONIC MONITORING ® 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC Si-AND-ALONE +wu+a ❑ 4.NO DISPENSERS ❑ 99.OTHER(Specify) .1-54 LEAK MONITOR MANUFACTURER: 4x`S5 MODEL M: 4'11fi LEAK SENSOR MANUFACTURER: J1.F59 MODEL q(S) J'x45x: DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ❑ a.YES ® b NO 4'41-S9 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ® b.NO +w'{" FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a YES ® b.NO 4'xxet UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. ® a.YES ❑ b.NO UDC CONSTRUCTION IS IN I SINGLE WALL ❑ 2.DOUBLE WALL Jwu° IF DOUBLE WALL: 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 Jww.w VII. PERIODIC SYSTEM TESTING I. ELD TESTING'. THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 41xl.6e L TE N E D MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MON ITIS AS REQUIRED 123 CCR 42i u it ® 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. +ww� ® 3. SPILL BUCKETS ARE TESTED ANNUALLY. 4-AW VIII. RECORD KEEPING The following monitoring/maintenance records are kept for this facility: +wl.nx E a-ALARM LOGS ❑ b.VISUAL INSPECTION RECORDS ❑ c,l"ANK INTEGRITY TESTING RESULTS ❑ if SIR TESTING RESULTS(and supporting documentation records) ❑ c.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 theirjob duties. +'nw'x REFERENCE DOCUMENTS MAINI AINED AT FACILITY/Checkall dust apply/ E THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) +'xveh E OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Requiredi Jaw'x ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 4.Wki ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 494",< ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION'. "HANDBOOK FOR TANK OWNERS - MANUAL AND 4w4sur STATISTICAL INVENTORY RECONCILIATION" ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS- OTHER(Specify): YSTEMS"OTHER(Specify): wtifwi 4AM% This facility has a"Designated UST Operator'who has passed the California UST System Operator Exam administered by the International Code Council +'xwm (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: 'r Operation of the UST systems in a manner consistent with the facility's best management practices. i 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 facility's UST Response Plan > Name(s)of contact persons)for emergencies and monitoring alarms X. COMMENTS/ADDITIONAL INFORMATION Provide additional comments here or indica ges with addition lormation on specific monitoring procedures are attached to this plan. 4.1-710 1 te how many pa °IS CLAP. XI. PERSONNEL RESPONSIBILITIES The UST Owner/Operator is responsible for ensuring that: I the daily/routine UST monitoring activities and maintenance of UST leak detection equipment covered by th_splan occurs.2.)all conditions that indicate a possible release are investigated,and 3.1 all monitoring records are matntatnedproperly. THE FOLLOWING PERSON(S)ARE RESPONSIBLE FOR PERFORMING THE MONI"PORING AND EQUIPMENT MAINTENANCE: NAME: 4AIlliji J'm-n_ -11'fLE I44yL6@2 P40"TEft J-xl.n NAME: u — TITLE: SST. M Ai rJ JxlaS 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 follow-tiaction. I . OPERATOR SIGNATURE CERTIFICATION:I certify at th nfor o ov ded herein is true and accurate to the best of my knowledge. APPLICANT SIGNATURE DATE,. +wr-rr REPRESENTING. LTanA Oumr/O rotor 2 FaiI1M1'Owner/O asali6of Orcn +11X146 APPLICANT NAME(print) Jwlax APPLICANTTITLE', AM1-7' A/oeE,J &,-fa M++srF UPCF UST-D(12/2007)-314 www.unidocs.org