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v .ii• UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN-(PaRe 2 of 2 VI. UNDER DISPENSER CONTAINMENT (UDC) MONITORING (Checkoff that a UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) ® 1.CONTINUOUS ELECTRONIC MONITORING ❑ 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE 4.NO DISPENSERS ❑ 99.OTHER(Specify) 49o-54a. LEAK MONITOR MANUFACTURER:VeedeP-Root 190.55. MODEL#:TLS-350 49656. LEAK SENSOR MANUFACTURER:Veeder-Rent 190.52- MODEL#(S):Liould Sehnor Series 794381EM 490.58. DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ® a.YES ❑ b.NO 490.59' UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN. Co a.YES ❑ b.NO 490'60 FAILUREIDISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ® a.YES ❑ b.NO 49061. UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. 0 a.YES 0 b.NO 490-62 UDC CONSTRUCTION IS: ® 1.SINGLE WALL ❑ 2.DOUBLE WALL 49063. IF DOUBLE WALL: 49664. UDC INTERSTITIAL SPACE IS MONITORED BY: ❑ a.LIQUID ❑ b.PRESSURE ❑ c.VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ❑ a.YES ❑ b.NO 49664b. VII. PERIODIC SYSTEM TESTING EJ L ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 49665. LEAK DETECTION ELD MUST BE PERFORMED. Pt RIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED,[23 CCR§2644.11 ® 2.SECONDARY CONTAINMENT COMPONENTS ARE: I FS ILD EVERY 36 MONTHS. 49066. ® 3. SPILL BUCKETS ARE TESTED ANNUALLY. 49667. VIII. RECORD KEEPING The following monitoring/maintenance records are kept for this facility: 490.68. ® a.ALARM LOGS ❑ b.VISUAL INSPECTION RECORDS ❑ c.TANK INTEGRITY TESTING RESULTS ❑ if SIR TESTING RESULTS(and supporting documentation records) ❑ e.TANK GAUGING RESULTS(and supporting documentation records) ❑ f ATG TESTING RESULTS(and supporting documentation records) ❑ g.CORROSION PROTECTION 60-DAY LOGS 21 h EQUIPMENT MAINTENANCE AND CALIBRATION RECORDS IX. TRAINING ® Personnel with UST monitoring responsibilities are familiar With all of the following documents relevant to their job duties: °YOir" REFERENCE DOCUMENTS MAINTAINED AT FACILITY (Check all that apply) ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) 49 % ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) 49069c ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 49069d. ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 49° % ❑ SWRCB PUBLICATION "UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 490691 This facility has a"Designated UST Opermue'who has passed the California UST System Operator Exam administered by the International Code Council 4A 70_ (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 rale 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 facility's UST Response Plan. ➢ Name(s)of contact person(s)for emergencies and monitoring alarms. X. COMMENTS/ADDITIONAL INFORMATION Provide additional comments here or indicate how many pages with additional information on specific monitoring procedures are attached to this plan. 490.21. • UST TURBINE&FILL SUMP MONITORING: PANEL MANUFACTURER. Veeder-Rout MODEL TLS-350 LEAK SENSOR MANUFACTURER:Veeder-Root MODEL#(St Liquid Sensor Scow 794380-208 • AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR DOUBLE WALL TANK(S) PANEL MANUFACTURER: Veeder-Roo[ MODEL#: TIS-3SO IN-TANK PROBE MANUFACTURER Veeder-Roo[ MODEL k: MAG • OVERFILL PREVENTION METHOD:Audible Visual and Ball Floor FAR ISD Software Installed XI. PERSONNEL RESPONSIBILITIES The UST Owner/Operator 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 FOLLOWING PERSONS)ARE RESPONSIBLE FOR PERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE: NAME: Debbie Jutla 49613_ TITLE:Operator 49073, NAME: CJ Jutla 49x74_ TITLE:Operator 49x75. The Designated UST Operator shall perform a monthly visual inspection of the facility,provide a report to the owner/operator,and infoml the owner/operator of any conditions that need follow-up action. XII. OWNER/OPERATOR SIGNATURE CERTIFICATION: I c rtify that the information provided herein is true and accurate to the best of my knowledge. APPLICANT SIGNATURE _�_ _ DA�TE:C 49677 REPRESENTING.01 Tmk Owner/ ralor 2.Faeihi 0xnu/O alor 3.AuUon,MR resmtalieeofow 490-76. 01/25/2010 APPLICANT NAME(print): 4111179. APPLICANT TITLE: 49679 Chevron Products Co./CHARLES BITTLE Chevron Retail HES Permit Desk rA4eary vre dvlyl Ttdd fa IevadaaJ: APPrvvad AP ed wiA Corultlou Daappevved baed All.,Si ature: Date: Ce tr n S,isi C—diti—