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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) VI.UNDER DISPENSER CONTAINMENT(UDC)MONITORING 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 490-54a 0 1.CONTINUOUS ELECTRONIC MONITORING El2.FLOAT AND CHAIN ASSEMBLY 1:13.ELECTRONIC STAND-ALONE 4x>•54b ❑4.NO DISPENSERS ❑99.OTHER(Specify): PANEL MANUFACTURER: vawtL spyr190 55 MODEL#: _" S50 490.56. LEAK SENSOR MANUFACTURER: V652a gar 49(-57 MODEL#(S): C)%f390 —:W-3 4190-58 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS a.YES ❑b.NO 4x1-59 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN a.YES ❑b.NO 4x_60. FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ® a.YES ❑b.NO 4'X1-61 UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. Il9 a.YES ❑b.NO 41X0.62 2.UDC CONSTRUCTION IS J91.SINGLE-WALLED ❑2.DOUBLE-WALLED 4%-63 IF DOUBLE WALLED: 4904.ta UDC INTERSTITIAL SPACE IS MONITORED BY: ❑ 1.LIQUID 2.PRESSURE ❑3.VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a.YES ❑b.NO 490-C4b VII.PERIODIC SYSTEM TESTING I. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 4911.65. LEAK DETECTION ELD MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. 23 CCR§2644.1 ❑2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS 4x0-M 3.SPILL BUCKETS ARE TESTED ANNUALLY. .49"7 VIII.RECORDKEEPING The following monitoring/maintenance records are kept for this facility: ❑Alarm logs 4x_68. ❑Visual Inspection Records 4m•v8b ❑Tank integrity testing results 4x0-6k ❑SIR testing results(and supporting documentation records). 4Wad ❑ Tank gauging results(and supporting documentation records). 4x0-68e ❑ATG Testing results(and supporting documentation records).4x1•68r ❑ Corrosion Protection 60-day logs 490-68g ❑Equipment maintenance and calibration records. 491•68h IX.TRAINING ($Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 4xk9a REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) [f� THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)490-69b OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)4%-r69e ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS•1X)-69d ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490-(9e ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION"491-69r ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"4x_698 ❑ OTHER(Specify):M69h.MGx This facility has a"Designated UST Operator'who has passed the California UST System Operator Exam administered by the International Code Council(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: • 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 > 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.41M-70 X. COMMENTS/ADDITIONAL INFORMATION Provide additional comments here or I d' to ho man pages with additional info t n on s cifrc monitorin pr cedures ar attached to this plan.49117 Br.sT Pt�Rc.T► � t5 c�lr�rlt7�p� OV� bra ct ') jS ��' c oto`�lo ttnlL �l - XI.PERSONNEL RESPONSIBILITIES 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 L IJ60i< o t tk f 4x0-72 TITLE 0LA/K test__ 490-73 NAME t t,*- - , 4x1-74 TITLE M 490-75 The Designated 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. APP LI ANT SIGNATURE 41A.76 DATE: 490-77 REPRESENTING:O I.Tank Ownir/C for O?.Facility 0—er/Ocernlor ❑3.Authors ReoruentaingofOwner APPLICANT NAME(print): 490-78 APPLICANT TITLE !r^-•-'e, 49079 N•� til c � ___ I PCF t ST-D(12/2007)3/3