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' UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN — Page 2 of 2) VI. UNDER DISPENSER CONTAINMENT(UDC) MONITORING (Check all that appityl UDC MONITORING IS PERFORMED USING THE FOLLOW}NG METHODS) ❑ I.CONTINUOUS ELECTRONIC MONITORING pr 2.FLOAT AND CHAIN ASSEMBLY ❑ 3,ELECTRONIC STAND-ALONE 1'"4ea' ❑ 4.NO DISPENSERS ❑ 99 OTHER(Specify) -- --- iV145( LEAK MONITOR MANUFACTURER 4`"135 MODEL#: LEAK SENSOR MANUFACTURER: 4'ML51 MODEL#(St 49.r4sn DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ❑ a,YES .NO a'N45D UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES (r--.r ,NO a'"""' FAILUREIDISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a L=1 YES b.NO 4`11 UDC MONITORING STOPS THE FLOWOVRODUCT AT 111E DISPENSER Er-a YES ❑ b NO a'"2UDC CONSTRUCTION IS L SINGLE WALL _.DOUBLE WALL IF DOUBLE WALL: +'"'�'• UDC INTERSTITIAL SPACE IS MONITORED BY: ❑ a,LIQUID ❑ b.PRESSURE ❑ c.VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENTOF THE UDC TRIGGERS AUDIBLEAND VISUAL ALARMS. ❑ a.YES ❑ b.NO VII. PERIODIC SYSTEM TESTING I.ELD TESTING. 'PHIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED LEAK DETECTION(ELDMUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS RE UI RED.h;CCR 41ru.q ® 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. ® 3 SPILL BUCKETS ARE TESTED ANNUALLY. a'""'r VIII. RECORD KEEPING The following mordtoring/maintenance records are kept for this facility: 49""`" ® a.ALARM LOGS ❑ b,VISUAL INSPECTION RECORDS ❑ c.TANK INTEGRITY TESTING RESULTS ❑ d.SIR TESTING RESULTS(and supporting documentation records) ❑ e.TANK GANGING 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 their job duties: +>tw9>s REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that amv) ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) {'a ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) c ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND a'A'09 STATISTICAL INVENTORY RECONCILIATION" ❑ SWRCB PUBLICATION:-UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 491''9). 4Y1 'A ❑ OTHER(Specify). 49""Fm This facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the Intemational Code Council Jy14"' (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: 1 Operation of the UST systems in a manner consistent with the facility's best management practices. Y 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 person(s)for emergencies and monitoring alarms. X. COMMENTS/ADDITIONAL INFORMATION Provide additional comments here=w icate how many pages with additional information on specific monitoring procedures are attached to this plan. Arco.•�:r�t� XI. PERSONNEL RESPONSIBILITIES The UST Owner/Operator is responsible for ensuring that: I.)the datly/routine UST monnonng activities and maintenance of UST leak detection equipment covered by bilis plan occurs.2)all conditions that indicate a possible release are investigated;,-:13)all monitoring records are maintained properly.._ THE FOLLOWING PERSON(St ARE RESPONSIBLE FOR PERFORMING THE MONITORING AND EQUIPMENT MAIN"r P.NANCE NAME: Rwz>R ,Kr 1tBNaBEz4 4%.72. TITLE: : •t'!�/CiZ'7iC( r"4'Is NAME: 2/Q•D IwJ620-r '9"0.74. TITLE. y 4111-75W__ The Designated UST Operator shall perform a monthly visual inspection of the facility,provide a n:port to the owner/operator,and in 10M the owner/operator of any conditions that need follow-uaction. *111 NE OPERATOR SIGNATURE CERTIFICATION:1 c tify tit the io r a ro ided herein is true and accurate to the best of my knowledge. APPLICANT SIGNATU / DATE:1 9� REPRESEMIVG. Tal Ouna/O to 1 Fa91ir.Onner/O nmr _ >NM1oriiMR ramnlice of Owner J9W 76 / — �y /Z APPLICIF AME(prim) nn-- ,,� 'M4r"- APPLICANTTITLE: aNb1° Dar,-w /wtl f3 li cy S i UPCF UST-0(12/2007)-3/4 www.unidocs.org