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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN— (Page 2 of 2) VI. UNDER DISPENSER CONTAINMENT(UDC)MONITORING hat(Check apply) DEC MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) ® L CONTINUOUS ELECTRONIC MONITORING ❑ 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE 490'54" ❑ 4.NO DISPENSERS ❑ 99.OTHER(Specify) 49o54h. LEAK MONITOR MANUFACTURER:Veeder-Root 490.55. MODEL p:TLS-350 49056. LEAK SENSOR MANUFACTURER: Veeder-ROOM 490.57, MODEL X(S):0794380-208 49o.5a. 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. ® a.YES ❑ b.NO 490'60. FAILUREMBCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ® a.YES ❑ b.NO 4s0'61. UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. ❑ a.YES ® b.NO 49 1 UDC CONSTRUCTION IS: ® I.SINGLE WALL [12.DOUBLE WALL 490x3, IF DOUBLE WALL: 490fi 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 490.1Ab. VII. PERIODIC SYSTEM TESTING 1.ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 49x65. kK&L2gjKQjQKkM MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED.lu CCR g2o 4 it ® 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490.66. ® 3.SPILL BUCKETS ARE TESTED ANNUALLY. 490-67. VIII. RECORD KEEPING 'The following monitoring/maintena oe records are kept for this facility: 49°69. ® 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 ATC TESTING RESULTS(and supporting documentation records) ❑ S.CORROSION PROTECTION 60-DAY LOGS ® h.EQUIPMENT MAINTENANCE AND CALIBRATION RECORDS IX. TRAINING ® Personnel with UST monitoring responsibilities are familiar with all ofthe following documents relevant to theirjob duties: 49x{9. REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) 490-6%. ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) 490.690. ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490-6d. ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490690. ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND 490.69E STATISTICAL INVENTORY RECONCILIATION" ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 49069% ❑ OTHER(Specify): 49u-69h 490.69L This facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council 49a-70. (ICC). The "Designated UST Operator"will train facility employees in the proper operation and maintenance ofthe UST systems annually,and within 30 days of hire.This training will include,but is not limited to,the following: D Operation ofthe UST systems in a manner consistent with the facility's best management practices. D The facility employee's role with regard to the monitoring equipment as specified in this UST Monitoring Plan. ➢ The facility employee's mle with regard to spills and overfills as specified in the facility's UST Response Plan. ➢ Name(s)of conmct penon(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. 490-71. Overfill 95%mechanical flapper XI. PERSONNEL RESPONSIBILITIES The UST Owner/Openuor is responsible for ensuring that L)the daily/mutine UST monitoring activities and maintenance of UST leak detection equipment covered b thi!jlan occurs;2)all conditions that indicate a-possible release are investigated_and 3.)all monitoring records arc maintained properly. THE FOLLOWING PERSON(S)ARE RESPONSIBLE FOR PERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE: NAME: Paul Chevalier 490'71. TITLE:Maintenance Manager/Designated Operator 490.]3, NAME: Romy Quiroz 49a-74 TITLE:Zone Manager 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-up action. XII. OWNER/OPERATOR SIGNATURE CERTIFICATION:I certifythat the informat' u provided herein is true and accurate to the best of my knowledge. APPLICANT SIGNATURE DATE: 490x7. Jan 4, 2012 RFPRESENTmG:®LTerJ<Owncr/0Facilit Own WO er 3.Authorized nWiae ofnwnc APPLICANT NAME(print): 49o-]e. APPLICANT TITLE: 490.79. Paul Chevalier Maintenance Manager UPCF UST-D(12/2007)-3/4 www.unidocs.org