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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN- (Pae 2 of 2) VI. UNDER DISPENSER CONTAINMENT (UDC) MONITORING (Check all that applig UDC MONITORING IS PERFORMED USING THE FOLLOWPNG METHOD(S) ❑ 1.CONTINUOUS ELECTRONIC MONITORING 9 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE 490-54* ❑ 4.NO DISPENSERS ❑ 99.OTHER(Specify) 4W54'b LEAK MONITOR MANUFACTURER: 490-55' MODEL if: 490.96 LEAK SENSOR MANUFACTURER: 49M7. MODEL tl(S): 490-58. DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ❑ a.YES NO 490-59. UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES 2'G,NO 49064` FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES [!b.NO 49"' UDC MONITORING STOPS THE FLOW OVODUCT AT THE DISPENSER. E7'a.YES ❑ b.NO 490-62 UDC CONSTRUCTION IS: 1.SINGLE WALL _DOUBLE WALL 49063. IF DOUBLE WALL: 490-64A 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 490-64b. VIL PERIODIC SYSTEM TESTING L ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 49065 LEAK DETECTION MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS RE UIRED.t23 ccR§2644.1 l ® 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490-66. 3.SPILL BUCKETS ARE TESTED ANNUALLY. 490.67. VIII. RECORD KEEPING The following monitoring/maintenance records are kept for this facility: 4=x)-69 ® a.ALARM LOGS ❑ b.VISUAL INSPECTION RECORDS ❑ C.TANK INTEGRITY TESTING RESULTS 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 their job duties: 496.694 REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) 49"9b OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) 490-69c. CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490694, CALIFORNIA UNDERGROUND STORAGE TANK LAW 490.69e, STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND 49tr69f STATISTICAL INVENTORY RECONCILIATION" ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 490.698. ❑ OTHER(Specify), 490-69h 490.691. This facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council 490.70 (ICC). The "Designated UST Operator"will train facility employees in the proper operation and maintenance of the UST sv_stems 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. Y The facility employee's role with regard to the monitoring equipment as specified in this UST Monitoring Plan_ • The facility employee's rode 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 icate how many pages with additional information on specific monitoring procedures are attached to this plan 4'71ril 06:1A 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 equipment covered [Itis an occurs,2. all conditions that indicate a possible release are investi ate Land 3. all monitoring records are maintained,properly. THE FOLLOWING PERSON(S)ARE RESPONSIBLE FOR PERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE: NAME: t4.[�1r.[94C d C+�a�}i 490-72. TITLE: �G f l�Jl iq'S"CE E' 490-73. NAME: 490 ta. TITLE: 490-75. 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-up action. XII. OWNER/OPERATOR SIGNATURE CERTIFICATION:I certify that the information provided herein is trite and aecutrate to the best of my knowledge, APPLICANT SIGNATU DATE: 4990-77 REPRESENnNG.rl I.Tank Ower/0 ator 2.rac lit (hvned0 ratty t� - 64009 ofO,encr 490.76 �.� / APPLIC NAME(print): 4W0-79. APPLI ANT TITLE' 490 79. 7 UPCF UST-D(12/2007)-3/4 wtrw.unldocs.orq