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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUNDSTORAGETANK MONITORING PLAN—(Pave 2 of 2 VI.UNDER DISPENSER CONTAINMENT(UDC) MONITORING (check all hat a UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) a 1.CONTINUOUS ELECTRONIC MONITORING ❑ 2.FLOAT AND CHAIN ASSEMBLY [13.ELECTRONIC STAND-ALONE 490W.Mbsob. _❑ 4 NO DISPENSERS _ _ _,_. 0.99 OTHER(Specify) LEAK MONITOR MANUFACTURER (^t r,1=htoo 99x55. MODELH: -4107c 490.56 LEAK SENSOR MANUFACTURER49x51. MODELM(S):�/300 ," eSS9 2- aw.ss. : �' � 1 1-✓<Y C r) DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. M a.YES ❑ b.NO d90S4- UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN. a a.YES ❑ b.NO 49660. FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. 9 a.YES ❑ b.NO 090d1 UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER V5 a YES ❑ b NO 49x6$. _ ____.... ._—__.... - __. _ 490.63. UDC CONSTRUCTION IS: ❑ I.SINGLE WALL �2.DOUBLE WALL 49x694 IF DOUBLE WALL: r�f 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 49069'. VII. PERIODIC SYSTEM TESTING 1.ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 49°'65. L E D MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. 23 CCR gx,9a.11 49x66 ® 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 49oa ® 7. 3.SPILL BUCKETS ARE TESTED ANNUALLY. VIII. RECORD KEEPING 491dB. The following monitoring/maintenence records are kept for this facility: ® 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.ATG TESTING RESULTS(and supporting documentation records) ❑ g.CORROSION PROTECTION 60-DAY LOGS ® h.EQUIPMENT MAINTENANCE AND CALIBRATION RECORDS IX. TRAINING Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to theirjob duties: 49x694 REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) ®THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) 4904% ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) 49x69`. ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490-W ❑ 49x69e CALIFORNIA UNDERGROUND STORAGE TANK LAW . ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION" 490-691 ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 49ebm ❑ OTHER(Specify): a9069t. This facility hes a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council 49 70, (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: D Operation of the UST systems in a manner consistent with the facility's best management practices. Y 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 facility's UST Response Plan. • Name(s)of contact person(s)for emergencies and monitoring alarms. X. COMMENTS/ADDITIONAL INFORMATION Provide additional comments here or indicate now manly pages with addirioml information on specific monitoring procedures are attached to this plan. 90.11. a I ° -', r XI. PERSONNEL RESPONSIBILITIES The UST OwnedOPeramr is responsible for ensuring thaC 1.)the daay/rodfine UST monitoring activities and maintenance of UST leak detection equipment covered by this plan occurs;2)all conditions that indicate apossible release are investigated. 3)all monitoring records are mamtainedpr y THE FOLLOWING PERSON(S)ARE RESPONSIBLE FOR PERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE 490.13 NAME: n TITLE: G�-�^�!?{" . J)1'N."'y) �.�C'*-v 494.74 a9an. NAME: ,l 71TLE: The Designated UST Operator shall perform a monthly visual inspection of the facility,provide a report to the owner/operator,and inform theowner/opemtor of any conditions that need follow-up action. XII. OWNER/OPERATOR SIGNATURE CERTIFICATION:I certify that the information prarvided herein is true and accurate to the best of my knowledge. 49x11 APPLICANT SIGNATURE - _._—�-- DATE: REPRESEN'rnln: I.TN Omirt 3.Ferilin Oxner/ err 3.Aw'ai>Wa reenuave of nxner 490.19.49076. 49019. APPLICANT NAME(print): APPLICANT TITLE: ek-e9. -11, f,1 77 T1, Cr`3'y UPCF UST-D(122007)-314 rvw3r.nrddors.ora