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-- UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN-(Page 2 of 2 he all �, I �'Y4'4 P est ri 1'' Tk�r n t M=1 4�•r,, UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) ® 1.CONTINUOUS ELECTRONIC MONITORING ❑2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE 490.54x. ❑ 4.NO DISPENSERS ❑ 99.OTHER(Specify) 490-54b. LEAK MONITOR MANUFACTURER 111 Co n 490-55. MODEL#:TS IOOo a-P 490-56. LEAK SENSOR MANUFACTURER: T ne O 1) 490.57. MODEL#(S):_ T3 P' t{l 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 490-60. FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUT-DOWN. JN a.YES ❑ b.NO 490-61. UDC MONITORING STOPS THE FLOW OF PRODUCT AT TIIE DISPENSER ❑ a.YES 01 b.NO 490-62- UDC CONSTRUCTION IS: 1.SINGLE WALL ❑ 2.DOUBLE WALL 490-63. IF DOUBLE WA 13.: 490-64.. 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 49064b. _ODT0WfEM TESTING ❑ i.ELD TESTING. THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490-65. E MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. 23 CCR 126u.11 ® 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490-66. ® 3.SPILL BUCKETS ARE TESTED ANNUALLY. �y 490-67. VItI ' i.G'bE$I1�iG The following monitoring/maintenance records are kept for this facility: 49x68. ® a.ALARM LOGS ® 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) ffiJ f.ATG TESTING RESULTS(and supporting documentation records) ❑ g.CORROSION PROTECTION 60-DAY LOGS ® h.E UIPMENT MAINTENANCE AND CALIBRATION RECORDS T .. ®Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties: 490-69� REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) ®THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) OM91, ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) 490.69.. ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 49069d ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490-69, ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND 49m9f STATISTICAL INVENTORY RECONCILIATION" ❑ S WRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 49069g, r� 49069h. W OTHER(SpeLify): 49069i. This facility has a"Designated UST Operator"who has passed the Califbmia 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. ➢ The facility employee's role with regard to the monitoring equipment as speed 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. ➢ Name(s)of contact person(s)for emergencies and monitoring a]arms. ^GU 1��'S/.ADMIT O�IZ.�`FI2�i�A`TxON _ Pro ide additional comments here or indicate how many es with additional information on specific monitoring procedures are attached to this plan. 490-71. a Q VR IM Sl, o T T0� tin rofl cT LL 6 E'IQNP( IBM The 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_ fly. THE FOLLOWING PERSON(S)ARE RESPONSIBLE FOR PERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE: NAME: �....:as 490-72. ')-)'I'I�E: 490-73. NAME: 19x74. TITLE: 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- action. CERTIFICATION:I certify that the information rovided herein is true and accurate to the best of my knowledge. APPLICANT SIGNATURE / DATE: 490-n. REPRESENTING: 1.Tank Owsr root aol" Owne ntor 3.Authaired R hive orOwxcr 490.76. `f APPLICANT NAME(print): 490-711. APPLICANT TITLE: 490.79. Gl/ ST it c UPCF UST-D(12/1007)-3/4 www.widoes.org £T0 80012 Xdd 90 :TT OHS 600Z/60/90