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AM AL <br /> UNDERGROUND STORAGE TANK <br /> MONITORING PLAN-PAGE 2 <br /> VL DISPENSER MONITORING <br /> MONITORING OF AREAS BENEATH DISPENSER(S)IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) Myo. <br /> ❑ 1.CONTINUOUS ELECTRONIC MONITORING OF UNDER DISPENSER CONTAINMENT(UDC) <br /> PANEL MANUFACTURER: M5t. MODEL#: Msa <br /> LEAK SENSOR MANUFACTURER: M53. MODEL#(S): Mse. <br /> WILL DETECTION OF A LEAK INTO THE UDC TRIGGER AUDIBLE AND VISUAL ALARMS? <br /> ❑ a.YES ❑ b.NO M55. <br /> WILL A UDC LEAK ALARM TRIGGER AUTOMATIC PUMP SHUTDOWN? <br /> ❑ a.YES ❑ b.NO M'6- <br /> WILL FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? ❑ a.YES ❑ b.NO M'7- <br /> 2.MECHANICAL ASSEMBLY(e.g.,FLOATAVD CHAIN ASSEMBLY)IN UDC TRIPS SHEAR VALVE IN CASE OF LEAK <br /> ASSEMBLY MANUFACTURER: <br /> ' <br /> M51- MODEL#(S):_ M59. <br /> El3.VISUAL MONITORING DONE: [I a.DAILY ❑ b.WEEKLY(Regmms.am�y wwval) M60• <br /> ❑ 4.NO DISPENSERS <br /> ❑ <br /> 99.OTHER(Specify) M61. <br /> VII. ENHANCED LEAK DETECTION <br /> ❑ L WE HAVE BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT WE MUST IMPLEMENT ENHANCED LEAK Mia <br /> DETECTION(ELD)FOR THE UST(S)COVERED BY THIS PLAN.PER 23 CCR§2644.1,ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED <br /> VIII. TRAIN NG <br /> REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) Mao. <br /> 1. THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) <br /> 2. OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) <br /> 3. THE FACILITY'S BEST MANAGEMENT PRACTICES(Required as of 1/01/2005) <br /> 4. CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS <br /> 5. ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW <br /> 6. ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND <br /> STATISTICAL INVENTORY RECONCILIATION" <br /> 7. ❑ SWRCB PUBLICATION:"WEEKLY MANUAL TANK GAUGING FOR SMALL UNDERGROUND STORAGE TANKS- <br /> 99.0 <br /> ANKS-99.❑ OTHER(Specify): Mat. <br /> Personnel with UST monitoring responsibilities are familiar with all of the above documents relevant to their job duties and can access those documents when needed. <br /> By January 1,2005 this facility will have a"Designated UST Operator"who has passed the operator exam administered by the International Code Council(ICC).. By <br /> January 1,2005,and annually thereafter,the "Designated UST Operator"will train facility employees in the proper operation and maintenance of the UST systems. <br /> This training will include,but is not limited to,the following: <br /> A Operation of the UST systems in a manner consistent with the facility's best management practices. <br /> D The facility employee's role with regard to the leak detection equipment. <br /> D The facility employee's role with regard to spills and overfills. <br /> ➢ Whom to contact for emergencies and leak detection alarms. <br /> For facility employees hired on or after January 1,2005,the initial training will be conducted within 30 days of the date of hire. <br /> IX. COM HNTRADDITIONAL INFORMATION <br /> Please use this section to include any additional UST system monitoring-related information(e.g.,additional information required by your local agency); Mas. <br /> ©U epi )J rtv A* o &J — D,<-o +o)o c---s <br /> X. PERSONNEL RESPONSIBILITIES <br /> AS OF I/l/05,THE"DESIGNATED UST OPERATOR"IDENTIFIED IN SECTION III OF THE CURRENT UST OPERATING PERMIT APPLICATION- <br /> FACILITY FORM WILL HAVE ULTIMATE AUTHORITY FOR PERFORMING THE MONITORING ACTIVITIES AND MAINTAINING LEAK DETECTION <br /> EQUIPMENT COVERED BY THIS PLAN,AND WILL PERFORM AND DOCUMENT MINIMUM MONTHLY VISUAL INSPECTIONS OF THE FACILITY'S <br /> UST SYSTEMS IN ACCORDANCE WITH 23 CCR§2715(b). <br /> XI. OWNER/OPERATOR SIGNATURE <br /> C ATION:I certify t4ikt the information provided herein is true and accurate to the best of my knowledge. <br /> t 1ER/OPERATOR,SIGNA `, REPRESENTING DATE: Mgr. <br /> El Owner M9o. <br /> _ ,�' ��' ❑Operator <br /> OWN ER/OPEtATOR NAME(print): t,, t ' { �) r`i9z OWNER/OPERATOR TITLE: /j M97 <br /> f C c /(,1`J (_-; <br /> (Agency Use Only) This plan has been reviewed and: A roved <br /> pp [I Approved With Conditions ❑Disapproved <br /> Local Agency Signature: Date: <br /> Comments/Special Conditions[ 00, T <br /> SJCEHD-d(07/03)-3/4 07/23/03 <br />