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06104/2009 08:39 2098585066 TWO GUYS FOOD PAGE 03/05 <br /> JJWD PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANK <br /> MONITORING PLAN (Page 2ort) <br /> Vt.UNDER DISPENSER CONTAINMENT(VDQ:MON!TORtNG --49D$4, <br /> —1. u-j5E—moriffoitme.is PERFORMED USING TIM FOLLOWING METHOD 490446 <br /> PLI.CONTINUOUS IZLEC.TROWTCM.ONrrOPJNG C3 2-FLOAT AND CITAIN ASSEMBLY Ej3.ELBCTk0NTrSTAND-ALONR <br /> 4.No DISITNSERS [199. R . ift! <br /> �,3-( MODEL.V: TLS-3 <br /> OL'ixidr ----------mm.mm <br /> PANEL MANUFACTURER: vy-eif?13 o. <br /> 4W57 1 g58 <br /> T)FTECTION OF A LFAX INTO ITEF UDC TRIGUERS AUDIBLE AND VISUAL ALARMS 7­' Iff a.,i7FS 0 b.No <br /> UDC LEAK ALARM TRIGGERS AUIUMATIC PUNT SHUTDOWN (Za.YUS Elb,NO 49(tAM <br /> PrA]LLrRE/r)19CONNECTIONOFUDC MONrTOItTNCISYSTEM TRJ(i(jFRSAUTOMATIC PTJKPSIIUTD()WN. n.YES ObmNO 4�1 <br /> UDC MONITORING STOPS THE FLOW OF PRODUCT AT TIM DISPTNS9R. n,YPS <br /> [1lxN0 47a67 <br /> Z.UDC CONSTRUCTION IS bj`..qrNGrE-WAJ.LPD I&IDOUBLF-WALLRD 1900 <br /> IF DOUBLE WALLED: FA. <br /> TJDC INTERSTMAT.SPACE TSMONITORED BY:--_ 1.L <br /> A LEAN WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS 9da.yF,% E3b.NO 4."b <br /> V11.PERIODIC SVSTEM TESTING <br /> t.TD)—TtsTiNG7-Tivis M—Try 14AS BEEN NOTIFIED By THF ST ATE WATER—RPMU RC*Fk 059TROI.-BOARD <br /> LEAS D-M-T;CTION(ELD)MUST!j3.Lf ED <br /> �Kyn ! �� RFQ <br /> ............ <br /> 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED RVFRV 36 MONTHS <br /> 3.SPILL BUCKETS ARE TESTED ANNUALLY. 490.61 <br /> VIU.RECORDKEEPING <br /> The f0flowmegn <br /> ntenenee reenrtls arc kept Fitt This fociRty <br /> Alarm loge 40µW, %Viswd1nqpccti,mRcoffdg�6* L&Sank integrity lcqti"g results 490*sa <br /> SMtesting miulm(and supporting documentation rcconls). 49n4,&i Uj Took ganging results(and wrpordug documentation T�vxrds). 4flmxa <br /> ❑ATG Testing rusths(and Aipporting docconsoution rocamrLi).AwuA( 0 Corrosion Protection(10-day lo&s 491 %j <br /> 4904911 <br /> UL TRAINING <br /> ..... ....... ....... <br /> Pasonricl wig,UST mmii1oring responsibilities wo familiar with AD of the following doctuccants rol"ant to their job duties. 49&69n <br /> IMFERENCE DOCUMENTS MAINTAINED AT FACI LITY(Cheek all that apply) <br /> THIS UNT)TRCROUND STORAGE TANK MONITORING PLAN(Required)4".096 <br /> CRATING MANUAT-1,FOR FTFC.TR0hIjV MONITORING EQUIPMENT(Rcqwtcd)4w4q,, <br /> [I CALIFORNJA UNDERGROUND STORAGE TANK RFC.TJT.ATl0NS49q694 <br /> [I CALIFORNIA UNDERGROUND STORAGE TANK LAW 4w4,9- <br /> D STATE WATER RRSOT3(CES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUALAND <br /> STATISTICAL TNVFNTORYRFrONCILIATrON'4"r <br /> [3 SWRCB PUBLICATION:"INDERSTAKDWO AUTOMATIC TANK GAUGING SYSTRMS"49o-ft <br /> Q OTM(Specifft mm. <br /> -IRITIliq iheility-hus o"Cicsignatod UST Operator'who has passed the Calirmio UST System operator niammbrinisomed b;7fiaIntemag;ij4I Code Council(ICC). <br /> The"DcsipawdUST Ottttlic7e"will tem facility mMloym <br /> . w the proper operation:oul mninl�, uc of the UST systems annually,and within 30 day%or him Irms <br /> mining will include,bra is act limited in,the following: <br /> The facility em"10you's role with legend to the monitoring equipment as specified in Oils UST Monitoring Plan <br /> )o The ro,11ity employee',mic with regard to spills andoverr,114 a4%pe6flod in the UST Response Plan <br /> > Nmmwofenllmctpc rgs)fwcmcrgcncic5mdmnitoringal=.q.4 io <br /> X'. cONjANNTS/AJ)D1T,.TOKAL INFOgmilow <br /> c additional is here or indicate how many page.,with additional infinmattion on specific monitoring procodu"we ultatchad to thus plan. <br /> X11 PERSONNEL RESPONSMFLITM <br /> The UST OweenOlacrator is ftstRoi..'bic for crswing that;1)the daily/routine UST and maintenaum of UST leak datectica equipment covered by <br /> this plan occuos,2)all conditions than indicate a pongible rc;case,nou%investigated,and 3)all monitoring monde arc maintained properly. <br /> The following=r;po <br /> .ZlWor performing the monitoring and equipment <br /> NAME O-A g_ 490.72 TTTLR -,c)V A/9 fV 4Wn <br /> NAME xlww ur 4W,74 TITLE OWMLV`' 490-75TbDe ', UAA� <br /> .g. Operator shall perform a monthly vistagi inspection of the rncility,provide a report to the owner/operator, and infinvin the ovacir/clocrabor of any <br /> conditions that need fblhiw-nrt outiou. <br /> XH.OWNER/.OPERATOR SIGNATURE ......... <br /> tr5� <br /> ,the iftiE <br /> -CERTIFIQTJON- certify I the ini;�mticm bcticin is true and accamate to the best of my knowledge. .........................ir <br /> 490 <br /> APPLI(;,ANT4luN upr MIM DATA! <br /> APPLICANT NAME(print): 49ILrxAPPLICANT TM.r: 490 N <br /> -ph's 5>Al DWNR n,- <br /> TJPCF UST-D(I 2/20M)3/4 <br />