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0 UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORINGPLAN (Page2of2) VI.UNDER DISPENSER CONTAINMENT(UDC)MONITORING L UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD ❑ I.CONTINUOUS ELECTRONIC MONITORING Q 2.FLOAT AND CHAIN ASSEMBLY El3.ELECTRONIC STANDALONE 496x6 ❑4.NO DISPENSERS ❑99.OTHER(Specify): PANEL MANUFACTURER: G;I M G 490-ss MODEL P Zb z0 49466. LEAK SENSOR MANUFACTURER: �rq 49657 MODEL H(S): ✓ 490.n DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑ a.YES [Sb.NO 490'39 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN 13 a.YES ®b.NO 49060. FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN 13 YES ®b.NO 49061 UDC MONITORING STOPS THE FLOW OF PRODUCT'AT THE DISPENSER. a YES � NO 49 61 L UDC CONSTRUCTION IS QI.SINGLE-WALLED ❑2.DOUBLE-WALLED 490.67 IF DOUBLE WALLED: UDC INTERSTITIAL SPACE IS MONITORED BY: III-LIQUID 2.PRESSURE 03.VACUUM 490-aa. A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a YFS ❑b.NO 490646 VIL PERIODIC SYSTEM TESTING 1. ELD TESTING: THIS FACILITY HAS SEEN NOTIFIED BY TI-]E STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 49466. LE ION ELD MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS RE UBRID. 23 CCR 2641.1 ®2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 06" M 3.WML BUCKETS ARE TESTED ANNUALLY. 49667 VIII.RECORDKEEPIIG The following monitoliog/mamlenence records are kept for this facility: ®Alar logs 4946sa ❑Visual Inspection Accords 490666 ❑Tank integrity testing results 4946& ❑SIR testing results(end supporting documentation records). 49461k! ❑ Tank gauging results(and supporting documentation records). 49Dbse ❑ATG Testing results(and supporting documentation records).49msf ❑ Corrosion Protection 60-day logs 4w-hes g Equipment maintenance and calibration records. 4906sh IX TRAINING QPersonnel with UST monitoring responsibilities are familiar with all of the following documents relevant to thcirjob duties. 494690 REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all That apply) ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)496691 IS OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)49069c ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490.694 ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490-696 ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION"49 t ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"49069s ❑ OTHER(Specify):mm M6a This facility has a"Desi grated U57 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 him.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 penon(s)for emergencies and monitoring alarms.490-70 X: COMMENTS/ADDITIONAL INFORMATION Provide additional comments here or indicate how many pages with additional tommustion on specific monitoring procedures am attached m this plan.49071 dve.- rvteatiaaPA-441 F14ppe✓ --Ie-+ -i- 'ISy XI.PERSONNEL RESPONSIBILITIES The UST Owner/Opcmtor is responsible for ensuring thin:1)the daily/routine UST monitoring activities and malate a nce 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 erson(s)are responsible for performing the monitoring and equipment main nco: NAME i 490-7I TITLE r�G6D:� ✓ 494n NAME '[" S' qV 490.74 TITLE r 49475 The Designated Operators I pert rm a monthly visual NsPec60n of the facility,provide a report to the owmdoperatoy 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. APPLICANT SIG14 0049076 DATE: 494P7 eretm Pacili enbr onud APPLICANT NAME(print). tl, 490.70 +90.. APPLICANT e�'LO(4Thj lie la V UPCF UST-D(12!2007)3/4