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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN — (Page 2 of 2) VI.UNDER DISPENSER CONTAINMENT (UDC) MONITORING (Check al/ that apply) UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) [11.CONTINUOUS ELECTRONIC MONITORING 9?L.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE J1}54' ❑ 4.NO DISPENSERS99.OTHE (Specify) 490-549. LEAK MONITOR MANUFACTURER: O 49035_ MODEL q: 490-56. LEAK SENSOR MANUFACTURER: 490.52 MODEL N(S): 490-51. DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ❑ a.YES ffog.NO 490'59 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ [!?a.YES NO 49O 60. FAILUREIDISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. �❑ ate.YES %e6 NO 490.61- UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. m'a YES ❑ b.NO 4S . UDC CONSTRUCTION IS 1r, SINGLE WALL ❑ 2.DOUBLE WALL 490-64. IF DOUBLE WALL: 09D64t 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 4au4u. VII. PERIODIC SYSTEM TESTING ❑ 1.FED TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD TI4AT ENHANCED 4'NIfi5. LEAK DETECTION ELD MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED 123 CCR 42644.11 ® 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS 4W ® 3.SPILL BUCKETS ARE TESTED ANNUALLY. {9 VIII. RECORD KEEPING The following monitoring/maintenance records are kept for this facility: 6Y1rx ® 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 ® It.EQUIPMENT MAINTENANCE AND CALIBRATION RECORDS IX. TRAINING Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to theirjob duties. 490-694 REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Checkall thatapply) ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) 490fi9E. ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) 490.% ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 49 9d. ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 49 % ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND 490 ff, STATISTICAL INVENTORY RECONCILIATION' ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 490-69& ❑ OTHER(Specify): 4906% 49ob9i. This facility has a"Designated UST Operator"who has passed the California USE System Operator Exam administered by the International Code Council 490-70 (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: Y 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)of contact person(s)for emergencies and monitoring alarms. X. COMMENTS/ADDITIONAL INFORMATION P ide additional convftnts her9fr inWa,t2jk,,riany p swish di[iona inform&[ n specific moN[bring p e ure are hedVya G� 4'"'-11 7," LL .QO/lC..�r.w �Yf� u.r z Jee/ 7 s XI. PERSONNEL I&SPONSIBILITIES The UST Owner/Operator is responsible for ensuring that. l.)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 FOLLO NCyPERjSp(.N(S ARER/�,S\PONSIBLE FOR PERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE: NAME: !/��{•�/*Z� 490-7. TITLE: ��_ a9o-n. NAME: 690'70- TITLE: 4911-75. The Designated UST Operaw hall 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- tion. I. OWNER/ RATOR SIGNATURE CERTIFICATION:Veerify that theNnforr4atilydirovided he i is true and accurate to the best of my o edge. APPLICANT SIGNAT DATE'. 121;1491 OCc745:7-7 REPRESENTING'. 1T.k O r°wr 2Faalil er/O r0-or(]3.AwM1onzedR MiWiveori) nx 490-76. 7 APPLICANT N E(prior). �0006 4147a' APPLICANTTITLE: 49(r9. UPCF US -D 2/2007)-3N www.unidws.org