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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORINGPLAN (Page2of2) VI.UNDER DISPENSER CONTAINMENT(UDC)MONITORING 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 490.54a ,,,ttt��111 490.54b El 1.CONTINUOUS ELECTRONIC MONITORING ps1 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE ❑4.NO DISPENSERS ❑99.OTHER S ify): PANEL MANUFACTURER: 490-ss MODEL#: 490.56. LEAK SENSOR MANUFACTURER: �V'Q 490.st MODEL#(S): 4s0.5s DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS C] a YES �NO 490.59 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN ❑ a.YES fiff�b.NO 49060. FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN, 10 a.YES ❑b.NO 490-61 UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. .YES ❑b.NO 4v 2 2.UDC CONSTRUCTION IS A SINGLE-WALLED ❑2.DOUBLE-WALLED 46ob3 IF DOUBLE WALLED: 490'6ae UDC INTERSTITIAL SPACE IS MONITORED BY: 1.LIQUID 0 2.PRESSURE El 3.VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a YES ❑b.NO 490E4b VII.PERIODIC SYSTEM TESTING ❑ I. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 40-65. LEAK DETECTION ELD MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. 23 CCR 2644.1 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 40 66 19�.SPILL BUCKETS ARE TESTED ANNUALLY. 49061 VIII.RECORDKEEPING The following monitoring/maintenance records are kept for this facility: rarm logs 4906sa Visual Inspection Records 49 81, ❑Tank integnty testing results 49 & SIR testing results(and supporting documentation records). 49ared ❑ Tank gauging results(and supporting documentation records). 49 68e ❑ATG Testing results(and supporting documentation records).49o.68r ❑ Corrosion Protection 60-day logs 49 sag 5, quipmem maintenance and calibration records. 49 68h IX.TRAINING .Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to theirjob duties. 49mL9e REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) M�THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)40.691, OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)49mw ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490.694 ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 4a69e ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION"490.69(` ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"490.69, ❑ OTHER(Specify):moo.M6% This facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council(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 UST Response Plan ➢ Names of contact person(s)for emergencies and monitoring alarms.400-70 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.4%-71 Q ve 7'ff Arv(rrh'M Fea*er o, 9-5-;/, 1Onlc 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 respons le for ormin the monitoring and equipment maintenance: (� NAMElq� I 490.rz TITLE U "— P RESiDE NT 490-13 NAME 490.74 TITLE 491,15 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 that need follow-up action. XII.OWNER/OPERATOR SIGNATURE CERTIFICATION:I certify ft the inforrtlation provided herein is true and accutate to the best of my knowledge. APPLICANT SIGNATURE � 490-76 DATE: 490.11 RJEPRES�G 0 1.Taok t1mittEhsait r 0 3.A mWive APPLICANT NAME(print): 090.71 APPLICANT TITLE: 4o79 'S iN ! iN H Vi - PRE UPCF UST-D(12/2007)3/4