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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) VI.UNDER DISPENSER CONTAINMENT(IJDC)MONITORING 490.s4a 1. UDC MONITORING IS PERFORMED USING THgfR`�5PLLOWING METHOD 490-54b ❑ 1.CONTINUOUS ELECTRONIC MONITORING A22.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE ❑4.NO DISPENSERS ❑99.OTHERS i a9o-ss MODEL#: 4%-56.58 PANEL MANUFACTURER: -- LEAK SENSOR MANUFACTURER: 49 57 MODEL#(S): 49ase DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS [...�.tea.YES b.NO 49as9 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWNV aa.YES [Ib.NO 4�60' FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ff a YES ❑b.NO 490�61 UDC MONITORING STOPS THE FLOW OF PRODUC' "THE DISPENSER. QVhIfES ❑b.NO 49o.6z 2.UDC CONSTRUCTION IS 1.SINGLE-WALLS- 112.DOUBL&WALLED 490,s3 490fi IF DOUBLE WALLED: UDC INTERSTITIAL SPACE IS MONITORED BY: ❑1.LIQUI 'd2.PRESSURE [13.VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a.YES ❑b.NO 490.64b VII.PERIODIC SYSTEM TESTING 1. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 49°-65. LEAK DETECTION ELD MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED.L23 CCR 2644.1 2.SECONDARY CONTAVOIENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 49°55 .SPII.L BUCKETS ARE TESTED ANNUALLY. 49057 VIII.RECORDKEEPING The following monitoring/maintensnce records me kept for this facility: Alarm logs 49o-6sa ❑Visual Inspection Recerds 49 68b ❑Tank integrity testing results 490a c LJ SIR testing results(and supporting documentation records). 490.68d ❑ Tank gauging results(and supporting documentation records). 490-68c ❑ TG Testing results(and supporting documentation records).4%68f ElCorrosionProtection 60-day logs 49ofisg Equipment maintenance and calibration records. 490a8h TX.TRAINING ersormel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 490L9a FERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)4sos9n OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)490fi9c ALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 49049d ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 49o-69e ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION'49669E ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"49o-e9g OTHER(Specify):M69h,M69i VThis facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council "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 employce's role with regard to spills and overfills as specified in the UST Response Plan ➢ Names of contact person(s)for emergencies and monitoring alarms.490-70 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.490-71 FAWk O✓�5/1 t IZI p0/2p 725G7741V In ECNf✓:CAC FzAA11W SC-r- 1 76 kJ.OAo/I ;zj01 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 person(s)are responsible for performing the monitoring and equipment maintenance: NAME 490-72 TITLE 49075 NAME 490-74 TITLE 49075 The Designated 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 thafneed_follow-up_action.__ XII.OWNER/OPERATOR SIGNATURE CERTIFICATION:I certify that the information provided herein is true and accurate to the best of my knowledge. ^/ 490-77 APPLICANT SIG TUBE �EmUYQL-Ipmagi ��4-k 490-]6 DATE: Q 1 /5- 2 0/�/ ILP//-- /// gomrAUMori R..wof APPLICANT NAME(print): t 490-79 APPLICANT TITLE: 490.79 bd2 EF,•� S M/ /!S G/ Ais1roe,/ 7- UPCF UST-D(12/2007)3/4