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L `.! FOI . ED UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN—(Page 2 of 2 VI.UNDER DISPENSER CONTAINMENT(UDC)MONITORING (Cneekall that a I 11^C MONITORING IS PERFORMED USING THE FOLLO ING METHOD(S) .1.CONTINUOUS ELECTRONIC MONITORING 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE 49LLSIc ❑ 4.NO DISPENSERS ❑ 99.OTHER(Specify) LEAK MONITOR MANUFACTURER: RJ¢ O 49035. MODEL M: / 490.56. LEAK SENSOR MANUFACTURER: 490-i7' MODEL q(S): ,94 r +'mss. DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. r-1.YES ❑ b.NO 490.59 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN. LW.YES ❑ b.NO 49060 FAILURE)DISCONNECFION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. FYES ❑ b.NO 4906[. Uv a UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. YES ❑ b.NO UDC CONSTRUCTION IS: Nf I.SINGLE WALL 2.DOUBLE WALL 45061 IF DOUBLE WALL: 490 r 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 490"69A VII. PERIODIC SYSTEM TESTING ❑ 1.ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED avows Lg&&QUggjQ&(ELW MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED.113 CCR12W.q M 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. w6a M 3.SPILL BUCKETS ARE TESTED ANNUALLY. m67. VIII. RECORD KEEPING The following monitoring/maintenance records are kept for this facility: +Sobs. M a.ALARM LOGS ❑ b.VISUAL INSPECTION RECORDS ❑ c.TANK INTEGRITY TESTING RESULTS ❑ d.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 M h.EQUIPMENT MAINTENANCE AND CALIBRATION RECORDS IX. TRAINING M Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to theirjob duties: - 49069. REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) M THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) 490690. M OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) 49 %. ElCALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS ,49069d. ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 49069e ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND 4m69r. STATISTICAL INVENTORY RECONCILIATION" ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 4v ft ❑ OTHER(Specify): 49069, 49o3m. M This facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council 4907. (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. > The facility employee's role with regard to spills and overfills as specified in the facility's UST Response Plan. > Name(s)ofcontact person(s)for emergencies and monitoring alarms. X. COMMENTS/ADDITIONAL INFORMATION Provide additional commrnts here s indicate how m y pages with additional information on specific Mention" procedure are attached tp this plaq,„�. 4va7i. %ihJK o(/ Fi'CG rQai ec.—ro�itfEcNr9nliC.Fz oPG1 sw' (JQa /u�38 S~ M. 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: 47-71 TITLE: 490.71 NAME: 490-74 TITLE: 490.75. The Designated UST Operator shall perform a monthly visual inspection of the facility,provide a report to the owner/operator,and inform the owner/operator of any conditions that need follow-u ion. XII NER/OP9AATOR SIGNATURE CERTIFICATION:I c rt( that ft inform 'on ided here" is t ue and accurate to the best of my knowledge. APPLICANT SIGNATU A, DATE: ^_ 490-77. i 'W- y r REPRESEMMQ❑I.Tank Owner/O LFocilily Owner/ or Ol.AmharizedR raenmiire ofUwn 490-K APPLICANT NAME(print): 49 78. APPLICANT TITLE: 490179. UPCF UST-D(1212007)-3/4 www.unidoes.org