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UNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUNDSTORAGETANK <br /> MONITORING PLAN— (Page 2 of 2) <br /> VI. UNDER DISPENSER CONTAINMENT(UDC)MONITORING (check all <br /> UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) that a ! <br /> ❑ ].CONTINUOUS ELECTRONIC MONITORING 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE 49o-54a <br /> ❑ 4.NO DISPENSERS ❑ 99.OTHER(Specify) 49a54b. <br /> LEAK MONITOR MANUFACTURER l/-O 450-15. MODEL#: 490-56. <br /> LEAK SENSOR MANUFACTURER: 490.37, MODEL N(S): 49 511. <br /> DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ❑ a.YES X b.NO 490-59, <br /> UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES J,b.NO 4900, <br /> FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES 25 b.NO 490.61. <br /> UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER, _ _ a YESb.NO aqo-cz. <br /> UDC CONSTRUCTION IS: L SINGLE WALL "O-'--"- —' <br /> IF DO WA L: ❑ 2.DOUBLE WALL 490.63. <br /> UDC INTERSTITIAL SPACE IS MONITORED BY: ❑ a.LIQUIDc. UUM 4% <br /> A Pr <br /> EAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ❑ a.YES ❑ b.NO <br /> 490fi4b, <br /> VIL PERIODIC SYSTEM TESTING <br /> .ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 4s 6sLEA DET TONED MUSTBORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS RE UIRED,123CCR 5z644.11 SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 49046. <br /> SPILL BUCKETS ARE TESTED ANNUALLY. VIII: RECORD KEEPING <br /> llowing monitorinp/maintenance records are kept for this facility: 4go-6sALARM LOGS ❑ b.VISUAL INSPECTION RECORDS ❑ c.TANK INTEGRITY TESTING RESULTS <br /> SIR TESTING RESULTS(and supporting documentation records) ❑ e.TANK GAUGING RESULTS(and supporting documentation records) <br /> ATG TESTING RESULTS(and supporting documentation records) ❑ g.CORROSION PROTECTION 60-DAY LOGSE UIPMENT MAINTENANCE AND CALIBRATION RECORDS :rsonnel with UST monitoring re sponsibilidesare familiar with ats relevant[o their jab dupes' 14�9& <br /> ENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply)IS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)ERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)LIFORNIA UNDERGROUND STORAGE TANK REGULATIONSLIFORNIA UNDERGROUND STORAGE TANK LAWATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND <br /> STATISTICAL INVENTORY RECONCILIATION" <br /> ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" <br /> ❑ OTHER(Specify): <br /> 490.694. <br /> ® This facility 1115 :1"Designated UST Operator"who has490.69'. <br /> passed the California UST System Operator Exam administered by the International Code Council 49o70. <br /> (ICC). The "Designated UST Operator"will train facility employees in the proper operation and maintenance of the UST systems annually,and within 30 <br /> days of hire.This training will include,but is not limited to,the following: <br /> Operation of the UST systems in a manner consistent with the facility's best management practices. <br /> Y The facility employee's role with regard to the monitoring equipment as specified in this UST Monitoring Plan. <br /> The facility employee's role with regard to spills and overfills as specified in the facility's UST Response Plan. <br /> ➢ Name(s)of contact person(s)for emergencies and monitoring alarms. <br /> COMMENTS/ADDITIONAL INFORMATION <br /> Provide additional comments here or indicate how any pages with additional information on speci(c m nitonng procedures are [[arched to this plan. 4w-i1, <br /> U L r Csw. Olt e r aY aU Y <br /> XI. PERSONNEL RESPONSIBILITIES'/ <br /> The US.T Owner/Operator is responsible for ensuring that: I.)the daily/routine UST monitoring activities and maintenance of UST leak detection equipment covered <br /> this Ip an occurs;2.)all conditions[hat indicate a possible release are investigate1n )all momtonna records are ma=ntaine opera_. _________ <br /> THE FOLLOWING PE SO (S) RESPONSIBLE FOR p.�RFORMING THE MONITORI�(G�A�ND frQU PMENT MAMTENANCE: <br /> NAME: rn -. 1 N�49 74 4' 27 > <br /> TTTLE: / QW�p(6—. a9o-r3. <br /> NAME: 49ar4. TITLE: ! 490-75. <br /> The Designated UST Operator shall perform a monthly visual inspection of the facility,provide a report to the owner/operator,and inform the owner/o er9ofconditions that need f)llow-u action. PXH- OWNER/OPERATOR SIGNATURE <br /> CERITFICATIO •I cer'f that the information rovided herein is true and accurate to the best of my knowled e. <br /> APPLICANTDATE: /qI REPRFSENr o I.TankOwner/ 2.Fecili Own.11 .a , 3.AUN--m R maa veofO er 490-r6. I ( L' / l0APPLIC NAM ( 'nt) er 4s0ae' APP ANT TI 'E: <br /> neS /4u �C�I�N/ ie�lKer� �arnWt <br /> UPCF UST-D(12/2007)-3/4 www.uaidoes.org <br />