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J Underground Storage Tank Monitoring Plan--Page 2 of 2 MONITORING OF AREAS BEN$ATH pISPENSER(S)IS PERFORMED U O p�OQ MING G HODS) (Call that"" ,.. ; El I.CONTINUOUS ELECTRONIC MONITORING OF UNDER DISPENSER CONTAINMENT(UDC) apply) Ksa PANEL MANUFACTURER: LEAK SENSOR MANUFACTURMODEL#: Mss'ER: �, M33' #(S): . WILL DETECTION OF A LEAK INTO THE UDC TRIGGMODELER AUDIBLE AND VISUAL ALARMS? WILL A UDC LEAK ALARM TRIGGER AUTOMATIC PUMP SHUTDOWN? ❑ a.YES ❑ b..NO Mss- WILL FAILUREID;SCONNECTION OF UDC MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? ❑ a YES ❑ b'NO :. ❑ 2.MECHANICAL ASSEMBLY(e.g.,FLOAT AND CHAIN ASSEMBLY)IN UDC TRIPS SHEAR VALVE IN CASE OF LEAK ❑ a YES ❑ b.NO ASSEMBLY MANUFACTURER: Msa. ❑ 3}7SUAL MONITORING DONE: ❑ a.DAILY MODEL q(S): ttsy, �/ ❑ b.WEEKLY(t4quires.au,�y appm+t} A/4.NO DISPENSERS ❑ 99.OTHER(Specify) ❑ 1.WE HA VE BEEN NOTIFIED BY 7IiE STATE WATER RESOURCES CONTROL BOARD THAT WE MUST IMPLEMENT ENI IANCED LFAK M70- � DETECTION(ELp)FOR THE UST(S)COVERED BY THIS PLAN PF.R 23 CCR§2644.1,ELD IS PERFORMED£VERY 36 MONTHS AS REQUIRED RE CE DOCl7MENTS MAIN AWED AT FACILITY(Check at[that apply) I. S UNDERGROUND STORAGE TANK MONITORING PLAN(Required) MHO 2. �PERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) 3. FACILITY'S BEST MANAGEMENT PRACTICES(Required as of January 1,2005) 4. CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 5. ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 6. SPATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION" 7. ❑ SWRCB PUBLICATION:"WEEKLY MANUAL TANK GAUGING FOR SMALL UNDERGROUND STORAGE TANKS" 99.❑ OTHER(Specify): Personnel with UST monitoring responsibilities ace familiar with all of the above documents relevant to their job duties and can access those documents when needed.t By January 1,2005,this facility will have a"Designated UST Operator"who has passed the California UST Sytem Operator Exam administered by the International Code Council(ICC). By July I.2005,and annually thereafter,the "Designated USF Operator"will train facility employees in the proper operation and maintenance of the UST systems.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 ➢ The facility employee's role with regard to the leak detection equipment. management practices. D The facility employee's role with regard to spills and overfills. D Whom to contact for emergencies and leak detection alarms. For facility employees hired on or after July 1,2005,the initial training will be conducted within 30 days of the date of hire. IX, COMMENTSIADDYT ONAL INFORMATION Please use this section to include any additionat UST system monitoring-related information(e.g.,additional information required by your local agency): Mes. Note regarding Section X.Pending certification of a Designated UST Operator,the following person has authority for performing the monitoring activities and maintaining leak detection equipment Covered by this plan. NAME: JOB TITLE: [b 'APPLICATION X. PEKSONNI� ESP.ONSIBILITIES AS OF JANUARY 1, 2005, THE "DESIGNATED UST OPERATOR" IDENTIFIED IN SECTION III OF THE CURRENT UST OPERATING PERMIT TION—FACILITY FORM WILL HAVE ULTIMATE AUTHORITY FOR PERFORMING THE MONITORING ACTIVITIES AND MAINTAINING LEAK DETECTION EQUIPMENT COVERED BY THIS PLAN,AND WILL PERFORM AND DOCUMENT MINIMUM MONTHLY VISUAL INSPECTIONS OF THE FACILITY'S UST SYSTEMS 1N ACCORDANCE WITH 23 CCR§2715(b). r c: Al .ONVNER/OPERATOR SIGNATURE CERTIFICATION:I certify that the information provided herein is true and accurate to the best of my knowledge. " OWNERIOPERATOR SIGNATURE n I2ESENTIN DATE: _ Niue. cJ l�w w�- �"wner M9o. `�C v rQ0 razor J J Ip OWNERIOPERATOR NAME(print): t M92- OWNER/OPERATOR TITLE: �� r[arty W tib efn :yn E+�v __TCrx,. (Agency Use Only) This plan has been reviewed and Approved L]Approved With Conditions ❑Disapproved Local Agency Signature: Date: 0 Comments/Special Conditions: UN-022A-315 www.unidocs.org Rev.10/14/03