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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) VI.UNDER DISPENSER CONTAINMENT(UDC)MONITORING 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 490-s4a 490396 Dt I.CONTINUOUS ELECTRONIC MONITORING 14 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE ❑ 4.NO DISPENSERS__❑99.OTMER( _ty): __ - J __ a9ns6, MO__ PANEL MANUFACTURER: awss DEL fl: LEAK SENSOR MANUFACTURER: -._ _ RSV rJ 490-sr f MODEL#(S): r1W I-C,J-)AW 49a59 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS a.YES Rb.NO 49-759 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN -a.YES Xb.NO 49u60. FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. r a.YES E b.NO 49x1-61 UDC MONITORING STOPS pTIHE FLOW OF PRODUCT AT THE DISPENSER. SI a.YES El b.NO 49-762 2.UDC CONSTRUCTION IS 1g11.SINGLE-WALLED ❑2.DOUBLE-WALLED 4%63 IF DOUBLE WALLED: °vada. _UDC INTERSTITIAL SPACE IS MONITORED BY: 1_LIQUID El2_PRESS;URE 1.VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a.YES AbNO 41"A41 VII.PERIODIC SYSTEM TESTING ❑ 1. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 4% 5. _ LEAK DETMTIQN(ELD)MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS-REQUIRED.�3 CCR§2644. C,2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 4� �3 SPILL BUCKETS ARE TESTED ANNUALLY 49053 VIIL RECORDKEEPING The following monitoring/maintenance records are kept for this facility: Alarm su5 logs 4sa Visual Inspection Records 49 69b ElTankintegrity testing results 4W-68C •SIR testing results(and supporting document:tion records). 4N. 6sd ❑ Tank gauging results(and supporting documentation records). 490-68a ❑ATG Testing results(and supporting documentation records).49 81` ❑ Corrosion Protection 60-day logs 490-6e9 Equipment maintenance and calibration records. 490-68h IX.TRAINING Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 4%)-(,9a REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) 14 THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)4%-69b OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)490-69C CALIFORNIA UNDERGROUND.STORAGE TANK REGULATIONS 49-769,1 CALIFORNIA UNDERGROUND STORAGE TANK LAW 490-69e STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION"490-69f ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"4w-695 ❑ OTHER(Specify):M6%.M69i ❑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: D Operation of the UST systems in a manner consistent with the facility's best management practices D 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.41x1-70 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.4v0-71 G k-Npeos 0 °S'/, XI.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 by this plan occurs,2)all conditions that indicate a possible release are investigated,and 3)all monitoring records are maintained properly. The followin person s)ar r onsib a for performing the monitoring and equipment mai tenance: NAME 410-72 TITLE 490-73 NAME 490-74 TITLE 490.15 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:I certify that the information provided herein is true and accurate to the best of my knowledge. APPLI NT SI NATURE 490-76 DATE: 4w-10 10 MG O I T 1 /O 2 F O /0 ❑3 A M ed 0. f 0 APPLICANT NAME(print): 41-15 APPLICANT TITLE: 490 r9 UPCF UST-D(122007)3/4