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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN-(Page 2 of 2) VI.UNDER DISPENSER CONTAINMENT(ADC)MONITORING (Checkall that apply) UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) 1.CONTINUOUS ELECTRONIC MONITORING ❑ 2.FLOAT AND CHAIN ASSEMBLY90.54-7 ❑ 3.ELECTRONIC STAND-ALONE 4 4.NO DISPENSERS ❑ 99.OTHER(Specify) 4971-54b. LEAK MONITOR MANUFACTURER: V 1Zp 490-55. MODEL#: 49055. LEAK SENSOR MANUFACTURER: y 'Q 490-5T MODEL#(S): 2-0 n 490-Se. DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. 9 a.YES ❑ b.NO 490.59 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ;R a.YES ❑ b.NO 090.60 FAILUREIDISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. 19)a.YES ❑ b.NO 49061. UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. tg a.YES ❑ b.NO 49063. UDC CONSTRUCTION IS: `1 L SINGLE WALL ❑ 2.DOUBLE WALL 49-763. IF DOUBLE WALL: 49064s 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 490646, VII. PERIODIC SYSTEM TESTING ❑ L ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 49065_ LEAKDETECTION ELD MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED.Iv CCR;Ss44.r1 ® 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490'66 ® 3.SPILL BUCKETS ARE TESTED ANNUALLY. 49042 VIII. RECORD KEEPING The following monitoring/maintenance records are kept for this facility: 49 , ® 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 ; E Personnel with UST monitoring responsibilities we familiar with all of the following documents relevant to theirjob duties: 49-76% REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) 4906 b ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) 49069c. ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 4904%. ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 4906% ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND 49069[. STATISTICAL INVENTORY RECONCILIATION' ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 49°'698 ❑ OTHER(Specify): 490496. 490.6%. ® This facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council 490-70. (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(mining 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. D The facility employee's role with regard to the monitoring equipment as specified in this UST Monitoring Plan. D 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 how many pages with additional information on specific moTtoring rocedures are attached to this plan. 490-71. 2 Cr ✓ T Q;l S XI. PERSONNEL RESPONABILITIES 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 RESPONSIBLE FOR PERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE: NAME: /1Ie� 49072 TITLE: (A 490-73. NAME: ff49074. TITLE: 49 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 certify that the information provided herein is true and accurate to the best of my knowledge. APPLICANT SIGNATURE DAATTE: 49077. MPRF3E G:0 1,Trak 0.71,4,;;;2.Fe i netl0 Sr 3.Amhon¢a R r.entmve down. 490.76 `'- APPLICANT NAME(print): 490-78. APPLICANT TITLE- 490'99 t r -S f t�,clO F/ Noll UPCF UST-D(12/2007)-3/4 www.unidocs.org Effective 01/19/08