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■ i <br />�i <br />i <br />r1 <br />UN)C>P�D PROGRAM CONS01MATED FORM <br />UNDIERGROUNI) MRACE TANK <br />NONMRING FLAN (Pip 2 of 2) <br />VL UNDER D><SPENSFA CONTAMMENT RMO MONY I )MG <br />1. UAC M 0IITORI N <br />IS PLMRMWD USING THE FOLLOWING M1L;Wo <br />- - �� <br />wo,s+„ <br />✓(1. CONTWRMWUS <br />NIC MONITORING ❑ 2. FLOAT AND CHAIN ASSI•MBLY ❑ 3. ELECTRONIC STA ND.AL.ONE <br />�as� <br />❑ 4. NO DISPLTlSE <br />❑ 99.07IB;R S <br />PANEL MANCiFA <br />�vass MODEL N: <br />` <br />psi <br />LEAK SENSOR MA <br />ACTURER: ! It s9asr MODEL #(S): <br />-S <br />DETECMN OF <br />INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS <br />„Q e. YES ❑ b. NO <br />49049 <br />UDC LEAK A <br />TRIGGERS AUTOMATIC PUMP SHC.IT'DOWN <br />18;p. YES ❑ b. NO <br />p060 <br />FAILURE I DISOO NECTION OF UDC MOXIMRiNO SYSTEM TRIGGERS AuromATIC PUMP BHvrDOW�t. <br />a YES [3 b. NO <br />UDC MONITORMM <br />STOPS THE FLOW OF PRODUCT AT THE DISPENSER. <br />43,& YES ❑ b. NO <br />2. UDC C0I1►ST u fi <br />4S Ot SINGLE-WALL® ❑ Z DOU R E -WALLED <br />VV ifnVMI.V WAN 911M. <br />- <br />A LEAK WITHIN THE SECONDARY CONfAMkff T•IT OF THE UDC 7RKIOERS AUDIBLE AND VISUAL ALARMS (l a YELS ❑ b. N0 <br />VII. PMODIC MTLM TESTING <br />i. I;LD iYS'ITN6: fAGlI.ffY-tG:S 8th: NOTII�iED.BC i'#Ie' ollm WA tE90 DOI�TRAI t'iQ�iTlO TART <br />MUST BEP PO I+Z t11DD10EL�Uy� �`e�w.y�� U�tlrl5AS 3 f73GYR t! ...... <br />SECONDAMA AIRF1EirtACl nwne Ina. '�' I •:i..L 3f1 i....... �, .` } {., i: F Mif+ <br />3. $ YYfiI LD AIfNTTALLY. <br />�edsr. <br />following net�ad�:� 19�t �r#�'_ , ,_: • . Y--� �- - :�. ___ �.1y _ .. <br />AlrpE}a lr►�`� V9AQi�1e°!� dr,.wi'�=°rata�owaul �.7UiL' T72. <br />3'sir In <br />1-�'- <br />r <br />rTtix(asawars�soanirl ' <br />acrd t�libpUEb iY�t)prdl.. {�� - A A I.L i� <br />l wig USr l:esponu'bs7itirssee Gotiiisr with all of the � doatmaMa relevant to their job dories. � . <br />MAMfAENED AT F'ACf3'Y (Check ali i> mq y) <br />TFIIS SiORACE TANTO I�O1ntIFd:(lidgd�:oosor <br />if' Ii1,SIR]TCIi�Qtlxl�0ii�fL}iRegstsoi� ,:-i.,.:.,. <br />t'A%lOIYIiIA STORAC3E TAI* RBOU ATIONS mm " — . <br />CALIFO"IA OUND STORAGE TANK LAW 49w% <br />(3 STATE WATER URGES CONTROL BOARD (SWRCB) PUBLICATION: "HANDSOOK. FOR TANK OWNER_ S - MANUAL AN) <br />STATISTICAL YSNi ORY RECONCILIATION' ~r <br />❑ SWRCe TUBLIC T101ri: "iiNDSR$TANDING AUTOMATIC TANK Gk[i(BiiGr SYST%M.S" 4wft <br />❑ OTMR (SpKeW) ►psi <br />This ficitity ipis a " igtrded UST Opeatot" who has ptosed the Catif=it [IST Systan Opma w Dam a4r�bured by &e .nunutiorW Code Cau of (ICC <br />T 1 wild tram'faaity - is of pral wopera'don aad�m lerkapas of zha TEST s &Ga ate} . and within 30 4"s of Mins Tisa <br />tmir&g with irraArde, bat ' limited to, the follov*w. <br />> Operation of the U systems in a manner ommistmi with the bcblity's beat arenttgemerrt practices <br />> The facility emplo 's role with regard tD the modwrnt$ eQr ipstt1 sa specified in this UST h&mkoring iPkm <br />> The facility 't Cols with YoW b aphis imd overfi s as specified n lira Uhl' Rapwm Rm <br />> Nama of canner s) for woorm m and raw* rbtg ah nnL 4so-7o <br />i�1E �S'% y/aY Y�OIr�IkO �Oi t t9�: t�1:flb!![i��-C 71CM111'0r+illitt�>� r�lRlt�l�d'Af ��i fCL' : �c 9�rad Cyt <br />kikaY > rtrtt t+rldrtaie Ya muAad powi I <br />" 'r1Y' i�rwisiQrrtnw(�il � a �ec>arr"prwlis� �C anal a�itip�itRrwsrlsitariarl <br />hfAr'ac' � se;..� Ylrri's .rx�„ <br />,amu arm <br />The ontow FORMa Morrdtlp visud irrspeation of the saw.provide a< sport m the awnerlaperaiar, red iattrorm Qte owrrerlortard r No <br />oor>Te0" tlro 404tfyv <br />A tSaC Ysiede` Qd bt+eE �i <br />APPLICANTNAN& r Ao- <br />APPLICANTnT - a. <br />UPCFU5T4D62*Mj <br />I <br />