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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN-(Page 2 of 2 he 4. I o " TN M D1iT eck�7r - r UDC MONITORING IS PERFORMED USING THE FOLLOWING METHODS) L CONTINUOUS ELECTRONIC MONITORING ❑2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE 490'54". ❑ 4.NO DISPENSERS ❑ 99.OTHER S 1 490-54b. LEAK MONITOR MANUFACTURER: 111 Co rl 490.55. MODEL h:Z 1000 a-p 490-56. LEAK SENSOR MANUFACTURER: Z.nC O r) 490'57. MODEL#(S): T3 P' t{1 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 SHUTDOWN. $) a.YES ❑ b NO 490-61. UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER ❑ a.YES b.N0 490-62 UDC CONSTRUCTION IS: 1.SINGLE WALL ❑ 2.DOUBLE WALL 490-63. IF DOUBLE WALL: 490-64a. UDC INTERSTITIAL SPACE IS MONITORED BY: [Ia.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. - ," `� -VAI, I'EI2.[pDIC'S�C�EMTESTING_ ❑ 1.ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT UTHANCEp 490-5. LEAS qMMIQN L MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. 23 CCR 42644.11 ® 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 49066. ® 3.SPILL BUCKETS ARE TESTED ANNUALLY. 49067. V 'R�iC 1w _ _ The following monitoting/maintenance records are kept for this facility: 490-69. ® 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) f.ATG TESTING RESULTS(and supporting documentation records) ❑ g.CORROSION PROTECTION 60-DAY LOGS h.EQUIPMENT MAINTENANCE AND CALIBRATION RECORDS TRINISG ®Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties49069.. REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) ®THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) 490-69b. ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) 490-69" 1 ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490-69d. ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490-69e ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND 490-69f STATISTICAL INVENTORY RECONCILIATION" ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" C90-69g' (� OTHER(Specify): {9069h. {90691. ® This facility has a"Designated UST Operator"who has passed the'Calif6mia 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 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. ➢ Name(s)of contact person(s)for emergencies and monitoring alarms. NTsAnDror .iozoi� Pro ide additional comments here or indicate how many es with additional information on specific monitoring procedures are attached to this plan. 490-7 L q e Ve rn Sh a TO% on rdo cT Pl,.L T_-A IBTI,ITIE'S'. . - The UST Owner/Operator is responsible for ensuring that:1.)the daily/routine UST monitoring activities and maintenance of UST leak detection equipment covered this pan occurs;2.)all conditions that indicate a possible release are investigated;and 3 J all monitoringrecords ere-maintainedproperly THE FOLLOWING PERSON(S)ARE RESPONSIBLE FOR PERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE: NAME: 490-72. ITTLE; 490-73 NAME: 490.74. 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-up action. WR/bPERA Tb1R�S�GNATURE CERTIFICATION:I certify that the information provided herein is true and accurate to the best of my knowledge- APPLICANT SIGNATURE DATE: 4W-77. REPMENrrNG: 1.lade Owarnmr -cif Owne 'otor❑3.Autlwrixd R eotadve of() x 49046. -' APPLICANT NAME(print). 490-71. APPLICANT TITLE: r 490-79. AL d46 UPCF UST-D(12/200'1)-314 www.unidoes.org £TO/8000 XVa 90 :TT 11HS 600Z/40/90