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• "-UNIFIED PROGRAM CONSOLIDATED FORM .UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) VI.UNDER DISPENSER CONTAINMENT(UDC)MONITORING I. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 490548 13 49a54b 1.CONTINUOUS ELECTRONIC MONITORING �2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRO*STAND-ALONE❑4.NO DISPENSERS ❑99.OTHERS i ): PANEL MANUFACTURER: 4sos5 MODELifpvy 49o-s6 LEAK SENSOR MANUFACTURER: 490'37MODELp490.58DETECTION OF A LEAK INTO THIP UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ES I b.NO 49°'59UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN S [�b.NO 49060. FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ® a YES ❑b.NO 990.61 UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER ® a YES ❑b.NO 49o.6z 2,UDC CONSTRUCTION IS (3l.SINGLE-WALLED ri 2.DOUBL -WALLED 49m IF DOUBLE WALLED: 49064e UDC INTERSTITIAL SPACE IS MONITORED BY: [ILLIQUID 2.PRESSURE 3.VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBL"4�8,UAL ALARMS ❑a.YES ❑b.NO 09p'64b VII.PERIODIC SYSTEM TES 1. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RCONTROL BOARD THAT ENHHANCED 49065. LEAK MIECTION(ELM MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EONTHS AS RE UIRED. 23 CCR 2644.1 IM 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 49066 3.SPILL BUCKETS ARE TESTED ANNUALLY. 490.67 VIII.RECORDKEEPING The following monitoring/mI�aIintenance records are kept for this facility: Alarm logs 4so.68a w Visual Inspection Records 490.68b ©Tank integrity testing res SIR testing results(and supporting documentation records). 49 d ❑ Tank gauging results(andocumentation records). 4o ❑ATG Testing results(and supporting documentation records).40.687 ❑ Corrosion Protection 60- 0.688 Equipmem maintenance and calibration records. 4o6a IX.TRAINING Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 4x.694 REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)40.696 ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)49069c ® CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490694 CALIFORNIA UNDERGROUND STORAGE TANK LAW 4906 STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION"490697 ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS`490.6% ❑ OTHER(Specify):M6914 6769; IB 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.4s0.7o X. COMMENTS/ADDITIONAL INFORMATION Provide additional comments hereor indicate how many pages with additional information on specific monitoring procedures areattached;-flus pl. 49071 D u,f r'JI Al ��a/ XI.PERSONNEL RESPONSIBILITIES The UST Owner/Operator is responsible for ereuring that:I)the dailyhoutine 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 ,S' C 4s0n TITLE S 490n NAME 4so.74 TITLE 49079 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.OWNERIOPERATOR SIGNATURE CERTIFICATION:I certify that the information provided herein is We and accurate to the best of my knowledge. APPLICANT SIGNA7 n/ 49076 DATE: Avon cP 0. Pcct:rrl'Iry O I T..t Ovm /na.. ❑2 F 'I' Own /0Sralor 0 �'/ //3 —C-/� APPLICANTyNAME(print): / 4978 APPLICANT TTI'LE: 490.79 UPCF UST-D(12!2007)3/4