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UNEF ED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANK <br /> MONITORING PLAN—(Page 2 of 2) <br /> VI.UNDER DISPENSER CONTAINMENT(UDC) MONITORING (Cheekall <br /> that apply) <br /> UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) <br /> 1.CONTINUOUS ELECTRONIC MONITORING ❑ 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE 490-54. <br /> 4.NO DISPENSERS ❑ 99.OTHER(Specify) 490.546. <br /> LEAK MONITOR MANUFACTURER: % Q 490-55. MODEL#: -7-L 35T> 490.56 <br /> LEAK SENSOR MANUFACTURER:_ k J 'Q 490-57 MODEL#(S): 2-09 490-58. <br /> DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. a.YES ❑ b.NO 490-59. <br /> UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN. a.YES ❑ b.NO 490.60, <br /> FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. Xa.YES ❑ b.NO 49 1. <br /> UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. a.YES [I b.NO 4904 <br /> UDC CONSTRUCTION IS: *1 1.SINGLE WALL E] 2.DOUBLE WALL 4�3. <br /> IF DOUBLE WALL: 49+64. <br /> UDC INTERSTITIAL SPACE IS MONITORED BY: ❑ a.LIQUID ❑ b.PRESSURE ❑ c.VACUUM <br /> A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ❑ a.YES ❑ b.NO 49)-646. <br /> VII. PERIODIC SYSTEM TESTING <br /> ❑ 1.ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490L5. <br /> LEAK DETECTION IELDI MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED.123 CCR g2 it <br /> ® 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490-66 <br /> ® 3.SPILL BUCKETS ARE TESTED ANNUALLY. 4% 7 <br /> VIII. RECORD KEEPING <br /> The following monitoring/maintenance records are kept for this facility: 490La <br /> ® a.ALARM LOGS ❑ b.VISUAL INSPECTION RECORDS ❑ c.TANK INTEGRITY TESTING RESULTS <br /> ❑ d.SIR TESTING RESULTS(and supporting documentation records) ❑ e.TANK GAUGING RESULTS(and supporting documentation records) <br /> ❑ f ATG TESTING RESULTS(and supporting documentation records) ❑ g.CORROSION PROTECTION 60-DAY LOGS <br /> ® h.EQUIPMENT MAINTENANCE AND CALIBRATION RECORDS <br /> IX. TRAINING <br /> ® Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties: 490 % <br /> REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) <br /> ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) 490696 <br /> ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) 49)-69c. <br /> ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 4%6 . <br /> ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490.69.. <br /> ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND 490 9C <br /> STATISTICAL INVENTORY RECONCILIATION" <br /> ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 490a91. <br /> ❑ OTHER(Specify): 490.6% <br /> 490b9i. <br /> This facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council 49070. <br /> (ICC). The "Designated UST Operator"will train facility employees in the proper operation and maintenance of the UST systems annually,and within 30 <br /> days of hire.This training will include,but is not limited to,the following: <br /> ➢ Operation of the UST systems in a manner consistent with the facility's best management practices. <br /> ➢ The facility employee's role with regard to the monitoring equipment as specified in this UST Monitoring Plan. <br /> ➢ The facility,employee's role with regard to spills and overfills as specified in the facility's UST Response Plan. <br /> ➢ Name(s)of contact person(s)for emergencies and monitoring alarms. <br /> X. COMMENTS/ADDITIONAL INFORMATION <br /> Provide additional comments here or indicate how many pages with additional information on specif¢mon1itoring rocedures are attached to this plan. 490-71 <br /> 6iy2V ✓ .� 0, L <br /> XI. PERSONNEL RESPONSIBILITIES <br /> The UST Owner/Operator is responsible for ensuring that: 1.)the daily/routine UST monitoring activities and maintenance of UST leak detection equipment covered <br /> by this plan occurs;2.)all conditions that indicate a possible release areinvestigated;and 3.)all monitoring records are maintained properly__ _ <br /> THE FOLLOWING PERSON(S)ARE RESPONSIBLE FOR PERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE: <br /> NAME: ('�/1 I ey. 490.7. TITLE: CA $ �' CY� 490-r3. <br /> NAME: 490-74_ TITLE: 490-75, <br /> 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 <br /> conditions that need follow-up action. <br /> XII. OWNER/OPERATOR SIGNATURE <br /> CERTIFICATION:I certify that the information provided herein is true and accurate to the beat of my knowledge. <br /> APPLICANT SIGNATURE SDATE49 ]] <br /> J _� <br /> dReml.Yveofpwer 49 ]b.REPRESENTINGD I.Tnk OweO <br /> 8 <br /> APPLICANT NAME(print): 690-78. APPLICANT TITLE: 490-7% <br /> C-"i S TA NO H N U"- <br /> UPCF UST-D(122007)-3/4 www.unidocs.org Effective 01/17/08 <br />