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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) VI.UNDER DISPENSER CONTAINMENT(UDC)MONITORING 49a54a I. VDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD °vas°b I.CONTINUOUS ELECTRONIC MONITORING [12.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE ❑4.NO DISPENSERS ❑99.OTHER(S 1 ): ___ PANEL MANUFACTURER: YY�t=� � 49°-55 MODEL#: (fi — 'j JV °so-se. LEAK SENSOR MANUFACTURER: E — °90'sr MODEL#(S) °vase DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS 5�,/&YES [3b.NO 490'59 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN a.YES ❑ 90'5° b.NO 4 , FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ,@,a.YES E]b.NO 4�1 UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. pd-a.YES ❑b.NO 4voa2 4a63 2.UDC CONSTRUCTION IS Of.SINGLE-WALLED [12.DOUBLE-WALLED IF DOUBLE WALLED: 4oa4a UDC INTERSTITIAL SPACE IS MONITORED BY: ❑I LIQUID ❑2.PRESSURE ❑3 VACUUM _ A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a YES ❑b.NO 49b VII.PERIODIC SYSTEM TESTING ❑ 1. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL HOARD THAT ENHANCED 4oa5. LEAK DET N ELD MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED.(23 CCR2644.1 _ .SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. - 4os6 4�r SPILL BUCKETS ARE TESTED ANNUALLY. VIII.RECORDKEEPING TheJJollowing monitoring/maint�notice records are kept for this facility: Alarm logs 4oaaa Visual Inspection Records 4odeb ❑Tank integrity testing results 4oasc 0 SSR testing results(and supporting documentation records). 49o�5ea ❑ Tank gauging results(and supporting documentation records). 4vassa RnS G Testing results(and supporting documentation records).4vassf EDCorrosion Protection 60-day logs 4vacss Mtquipment maintenance and calibration records. 490�68a IX.TRAINING Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to theirjob duties. 4oc9a REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) ❑ THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)4as% ❑ OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)4o.69c ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 4%-6W ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 4os9a ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION'490-W ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"4ob9g ❑ OTHER(Specify):m691.M6 Lj This facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council(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: ➢ 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.49a70 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.4o-71 XL 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 this plan occurs,2)all conditions that indicate a possible release are investigated,and 3)all monitoring records are maintained properly. The following person(s)are responsible for performing the monitoring and equipment maintenance. NAME 472 TITLE 4 7 NAME 4va74 TITLE 49a15 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. - XIL OWNER/OPERATOR SIGNATURE CERTIFICATION:Ice 'fy that e' orm tion provided herein is true and accurate to the best of my knowledge. APPLICANT SIGNATURE 4ar6 DATE: °90'°0 03 o� L T - un / 2.FaCL11 . / 3.A �' f APPLICANT NAME(print): 690'rg APPLICANTTITLE: 1 4ar9 /eh<s N a UPCF UST-D(122007)3/4 / 9�j