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RECEIVED UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) I VI:'UNDER DISPENSER,CONTAINMENT(UDC)MONITORING,;, HEALTH,DEPARTMENT, 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 496 sr6 a90.Sab ® 1.CONTINUOUS ELECTRONIC MONITORING ❑ 2.FLOAT AND CHAIN ASSEMBLY ❑ 3,ELECTRONIC STAND-ALONTE ❑4.NO DISPENSERS ❑99.OTHER S eci : PANL MANUFACTURER: 0 r 490-55 MODEL#: 490-56, b LEAK SENSOR MANUFACTURER: 1 490.37 MODEL#(S): 490-58 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ® a.YES ❑b.NO 490-59 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN ® a.YES ❑b.NO 490-0. FAILURE/DISCONNECTION OF UDC MONCPORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN, 0 a.YES ❑b,NO 49"1 UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER, C2�a.YES ❑b.NO 490-62 2.UDC CONSTRUCTION IS P 1.SLNGL£-WALLED ❑2.DOUBLP-WALLED 490.63 IF DOUBLE WALLED: 496-644 UDC(INTERSTITIAL SPACE IS MONITORED BY; ❑ I.LIQUID ❑2 PRESSURE ❑3.VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a.YES R b.NO 490-64b VII.(PERIODIC SYSTEM TESTING' 1. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490 6s. LEAK DETECTION ELD MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS RE UIRED. 23 CCR 2644.1 [�2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS, 490'66 3.SPILL BUCKETS ARE TESTED ANNUALLY. 490-67 VIII.RECORDKEEPING The following monitodrig/maintenance records are kept for this facility: M Alarm logs 490-696 ❑Visual Inspection Records 490.68b ❑Tank integrity testing results 490.680 ❑SIR testing results(and supporting documentation records). 490-680 ❑ Tank gauging results(and supporting documentation records). 49o.ae ❑ATG Testing results(and supporting documentation records),490OF ❑ Corrosion Protection 60-day logs 490-6ig ❑Equipment maintenance and calibration records. 490-68b IX.TRAINING. ❑Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 490-694 REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)490.696 ❑ OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)490-690 Q CALIFORNIA UNDERGROUND STORAGE TANKREGULATIONS490-69d ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490.690 ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION; "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION"490-69f ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SY$TEMS"ago-69g ❑ OTHER(Specify):M69h,M69i This facility has a"Designated UST Operator'who has passed the California UST System Operator Exam administered by the International Code Council PCC), The"Designated UST Operator"will train facility employees in the proper operation and maintenance of the UST systems annually,and within 30 days of hire.This training will include,but is not limited to,the following: Operation of the UST systems in a manner consistent with the facility's best management practices The facility employee's role with regard to the monitoring equipment as specified in this UST Monitoring Plan D The facility employee's role with regard to spills and overfills as specified in the UST Response Plan Names of contact person(s)for emergencies and monitoring alarms.490.70 X. COMMENTS/ADDITIONAL 14ORMATIO Provide additional comments here or indicate how many pages with additional information on specific monitoring procedures are attached to this plan,490-71 XI:PERSONNEL RESPONSIBILITIES The UST Owner/Operator is responsible for ensuring that:1)the daily/routine UST monitoring activities and maintenance of USI'leak detection equipment covered by this plan occurs,2)all conditions that indicate a possible release are investigated,and 3)all monitoring records are maintained properly. The h llowi ��rson(s)are responsible for performing the monitoring and equipment maintenance: 1 V ✓T 49o•72 TITLE 49x73 NAME N )(4 49o-74 TITLE v 490-7$ The Designated Operator shall perform a monthly visual inspection of the facility,provide a report to the owner/operator,and inform the owner/operatoiAf any conditions that need follow-up action, XII.OWNERIOPERATOR SIGNATURE CERTIFICATION:I cetirify that the information provided herein is true and accurate to the best of my knowledge, APPLICANT SIGNATURE 490-76 DATE; 490 n _ gJ L1 :. )3 APPLICANT NA print): 0-90-70- APPLICANTTITLE; 490-79 It t�!Q K GJr e, UPCF UST-D(1212007)314