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UNIFIED PROGRAM CONSOLIDATED FORTH UNDERGROUND STORAGE TANK MONITORING PLAN — (Page 2 of 2) VI. UNDER DISPENSER CONTAINMENT (UDC) MONITORING (Check all that 1 >: IDC MONITORING 1S PERFORMED USING THE FOLLOWING METHOD(S) Al CONTINUOUS ELECTRONIC MONITORING ❑ 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE 490-54a ❑ 4.NO DISPENSERS ❑ 99.O_TH_E_R_(Specifj) 490-546 LEAK MONITOR MANUFACTURER: 49Cti55 MODEL k: -TLS —351D 490-56 LEAK SENSOR MANUFACTURER._ U E E QED — Q OpT 09p S7 MODEL tl(S): "1 y u 3 A e--3 L 3 490-58 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. a.YES ❑ b.NO 490-5" UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN. a.YES ❑ b.NO 490-60 FAILUREIDISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN a YES ❑ b.NO "- UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. a.YES ❑ b.NO 490.6_' UDC CONSTRUCTION IS 10 I SINGLE WALL ❑ 2.DOUBLE WALL 490.63. IF DOUBLE WALL: 490-lata. UDC INTERSTITIAL SPACE IS MONITORED BY: ❑ a.LIQUID ❑ b.PRESSURE ❑ c.VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ❑ a.YES ❑ b.NO 490-646 VII. PERIODIC SYSTEM TESTING L ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490-65, LLAK D. CTION E DJ MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. 23 CCR§2644.11 ® 2. SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490-60-. ® 3. SPILL BUCKETS ARE TESTED ANNUALLY. 490.67 VIII. RECORD KEEPING The following monitoring/maintenance records are kept for this facility: 490-69. ® a.ALARM LOGS C3 b.VISUAL INSPECTION RECORDS ❑ c.TANK INTEGRITY TESTING RESULTS ❑ d.SIR TESTING RESULTS(and supporting documentation records) ❑ e-TANK GAUGING RESULTS(and supporting documentation records) ❑ f.ATG TESTING RESULTS(and supporting documentation records) ❑ g.CORROSION PROTECTION 60-DAY LOGS h.EQUIPMENT MAINTENANCE AND CALIBRATION RECORDS IX. TRAINING Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties: 490-6% REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that applt) THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) 490696. OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) 490-69c. ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490.694. ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 4906%. ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND 490-W- STATISTICAL INVENTORY RECONCILIATION" ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 490.699 ❑ OTHER(Specify): 490-69h. 490-M. This facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council 490-70- (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. D 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 facility's UST Response Plan. D Name(s)of contact person(s)for emergencies and monitoring alarms. X. COMMENTS/ADDITIONAL INFORMATION P((ovide additional m nts}�eQr Indicate how m n ages with ditipnal infQrtna i ons ific onitorin ores p� atta hed to this plan. 490-71. It UT MATH_ V v� M ; GFF 1Ait1RNt LA&E SC:WLZD T<) rN6 5uM lS ENSGK 89 Ao6vvUR*XS�S er-% FMk-S F v u XI. PERSONNEL RERPMNRIRTLITIES 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 thisplan occurs,2)all condlUons that indicate apossible release are investijzated�and 3.)all monitories records are maintained properly; THE FOLLOWING PERSON(S)ARE RESPONSIBLE FOR PERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE NAME: J A S D-1�- L H K D11- 490-7 TITLE: (A EVA gc 4- 490-73, NAME: C L _ 5V SHfol,ei A- 490.74 TITLE: M EM Pa&= 490.75, 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 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. APPLICANT SIGNATURE DATE 490-77. ` PRESENTINGAD 1 Tank OwnerlOperator a 2.Facility Owner/ tar 0 3.Authorized Repreumtative of Owner 490-76 APPLICANT NAME(print) 490-78:_ APPLICANT TITLE' 490-79 ICULAECP C• S1tA- ,MX Mem IL UPCF UST-D(11/2007)-3/4 www.unidocs.org