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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN (page 2 of 2) VI.UNDER DISPENSER CONTAINMENT(UDC)MONITORING I. CMONITORTNGIS PERFORMED USING THE FOLLOWING METHODOCJ +�->+• 999 ae 1.CONTINUOUS ELECTRONIC MONITORING 112.FTAA7AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE ❑4.NO DISPENSERS ❑99.OTHER(S ity); PANEL MANUFACTUP.M i MODEL H: 9so LEAK SENSOR MANUFACTLWIL- "0'S71 MODEL q(S): 490-58 DETECTION OF A LEAK INTO THE UDC TRIGGhKS AUDIBLE AND VISUAL ALARMS a YES ❑b.NO ° UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN s42r&YES ❑b.NO FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN, � �6 /a•YES [Ib.NO a9a-61 UDC MONITORING STOPS T FLAW OF PRODUCT AT THE DISPENSER f,Ora.YES ❑b.NO a9P62 2,UDC CONSTRUCTION IS 1.SINGLE-WALLED ❑2.DOUBLE•WALLED ago IF DOUBLE WALLED: +sa66s UDC INTERS1111AL SPACE IS MONITORED BY' EILLIQUID 2.PRESSURE C13.VACUUM _ A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a YES ❑b.NO 4°66ab VII.PERIODIC SYSTEM TESTING I. ELD TESTING: THIS FACILrrY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 49063. _ LFIE j2ETffaJQN.(FLEA MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS A29VIRED.(23 CCR li2644-1_ .SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS, °Yp66 3.SPILL BUCKETS ARE TESTED ANNUALLY. �gp61 VIII.RECORDKEEPING _Th�el'ollawing monimring/mainanana records are kept for this facility; �Alarm logs e90-68. Visual Inspection Records aoo.sab ❑Time integrity Dancing results 49usao []SIR testing results(and supporting documentation records), +9M66d ❑ Tank gauging Results(and supporting doe maaatieo records), eso6t• ❑ TG'r s ng results(and supporting doeumontadon rewrds)a9otaC E3 Corrosion Protection 60-day logs .wcae Equipment mainteruuce and calibration records. mx.6ea IX.TRATNING te Personnel with UST monitoring responsibilities are femiliar with all ofthe following documents relevant to their job duties. REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) %PrTHIS UNDERGROUND STORAGE TANK MONITORING PLAN(Require(l)4q .% vffOPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)49"- ). ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 4%.694 ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 99x.699 ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION'aeo 6 r ❑ SWRCB PUBLICATION:°UNDERSTANDINOAUTOMATICTANKGAUGINGSYSITW"49o.6h OTHER(Specify):M(94 m" Thi9 foeility has a"IDcsignucd UST Operator"who has passed die California UST System Operator 4'rnm administered by the International Code Council(TCC), The"Designated UST Opened["will train facility employees in the proper operation and maintenance of the UST systems annually,and within 30 days of hire.This training will iacludc,but is not imired to,the following; D Operation of the UST systems in a mawer consistent withthe facility's best managemem practices • The facility employee's role with regard to the monitoring equipment as specified in this UST Monitoring Plan Y The facility employci a role with regard to spills and overfills as specified in the UST Response Plan > Names ofcontact person(s)for emergencies and monitoring alarms.990-ro M COMMENT'S/ADDITIONAL INFORMATION Provide additional comments here or indicate how many pages with additional infornution on specific monimring procedures are attached W this plan.aso-r i M.PERSONNEL RESPONSIBELITMS y�( The UST Owner/Operator is responsible for ensuring than I)the daily/roudne UST monitoring activities and inemmaano BUST lea deurodon equipment covere this plan occurs,2)all conditions that indicate a possible release are investigated,and 3)all monitoring records are maintained properly. The folioon( ) r res sible for performing the monitoring and oqufpment main[ _ NAMErx- .0-m TITLE r—--rI/J�-�7y E7' avo-ir NAME +9o-ta TITLE q 14bt3 The l ions that rami shall a erns a monthly Vlau91 inspection of the Paoiliry,provide a report CO rh n er/operator,arta inform the owner/opera[or of any conal ions Thai need follow-up action. XII.OWNER/OPERAXOR SIGNATURE CERTIF.ICA N:T anti Ih e' ation provided herein i9 true and accurate to the best of my knowledge. APPLTC A a 76 DATE; aso-n APPLICANT NAME(print): 'sore APPLICANT TITLE: A)/ UPCF UST-0(12/2607)3/4 60/60 39Vcl 9669 00dV SVOdVA A BTOCBP660Z TZ:ZT 800Z/LZ/80