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• Y UPCF UST -D (12/2007) 3/4 UNIIRRED PROGRAM CONSOLIDATED FORIW UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) VI. UNDER DISPENSER CONTAINMENT (UDC) MONITORING 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 49654. 5 rte/49646 Xsl 1. CONTINUOUS ELECTRONIC MONITORING 112. FLOAT AND CHAIN ASSEMBLY ❑ 3. ELECTRONIC STAND-ALONE ❑ 4. NO DISPENSERS 1:199. OTHER (S i ): PANEL MANUFACTURER: .9688 MODEL #: _ O 49636, 49697 LEAK SENSOR MANUFACTURER: =Qz 6bb 1 MODEL #(S): .p _ 3 49669 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS 2ka YES ❑ b. NO 49669 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN ❑ a. YES NO 490'60 FAILURE / DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a. YESrgyy'p. NO 490b1 UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER ❑ a. YES rap. NO 49662 2. UDC CONSTRUCTION IS ❑ L SINGL&WALLED ❑ 2. DOUBLE -WALLED 4� IF DOUBLE WALLED: 49654. UDC INTERSTITIAL SPACE IS MONITORED BY: 0 L LIQUID 0 2. PRESSURE 0 3. VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑ a YES ❑ b. NO 49"A VII. PERIODIC SYSTEM TESTING 1. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 49068. LEAK DETECTIOND MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. 23 CCR 2644.1 ❑ 2. SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 49666 ❑ 3. SPILL BUCKETS ARE TESTED ANNUALLY. 49667 VIII. RECORDEEEPING fal lowing monitoring/maintenance records are kept for this facility: 4Th Alarm logs 49058. a7. Visual Inspection Records 49668h Tank integrity testing results 49068c testing results (and supporting documentation records). 4905 1 21 Tank gauging results (and supporting documentation records). 4o69e RSIR ATG Testing results (and supporting documentation records). 49a58f ❑ Corrosion Protection 60 -day logs 4996rg oEquipment maintenance and calibration records. 49668h M TRAINING Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to thehjob duties. 490.59. RE2RENCE DOCUMENTS MAINTAINED AT FACILITY (Clack all that apply) THIS UNDERGROUND STORAGE TANK MONITORING PLAN (Required) 490696 PERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT (Required) 49069c CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 49669. CALIFORNIA UNDERGROUND STORAGE TANK LAW 4 % STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION" 49a59f SWRCB PUBLICATION: "UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 496698 ❑ OTHER (Specify): M69h ma J11 F 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 D The facility employce's role with regard to spills and overfills as specified in the UST Response Plan • Names of contact pemon(s) for emergencies and monitoring alarms. 4s67o X. COMMENTS/ADDITIONAL INFORMATION Provide additional comments here or indicate haw many pages with additional information on specific monitoring procedures are attached to this plan. 49671 DUer�il/ Proler�+� r g6cp t✓b& Z.IZ74;i M. PERSONNEL RESPONSIBIUTIES The UST Owner/Operamr 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 foil ng person(s) are responsible for performing the monitoring and equipment maintenance NAME G4i 49672 TITLE i 49673 NAME 49674 TITLE 49675 The Designated Operator shall perform a monthly visual inspection of the facility, pmvide a report to the owner/ tor, and inform the owner/operator of any conditions that need follow-up action. XII. ONVNER/OPERATOR SIGNATURE CERTIFICATION: I certify that the information provided herein is true and accurate to the best of my knowledge. APPLICANT S Tl1RE 49676 DATE: 'J Q 490-77 T r/ Iff F=11W 0—er/Omrwor O 3. A ihmz 0. r ( n r APPLICANT NAMWrmt): , 496va APPLICANT TITLE: /' 49679 UPCF UST -D (12/2007) 3/4