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UNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANK <br /> MONITORING PLAN (Page 2 of 2) <br /> VI.UNDER DISPENSER CONTAINMENT(UDC)MONITORING <br /> 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 490-54490-54b <br /> ;%1.CONTINUOUS ELECTRONIC MONITORING ❑ 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE <br /> ❑ 4.NO DISPENSERS ❑99.OTHER(moi)__ <br /> ----------------------- --------- --- — -- <br /> PANEL MANUFACTURER: v'4F_ 41'P_ Vp� — 490.55 1 MODEL#: _ _TL-s-3so 490-56. <br /> LEAK SENSOR MANUFACTURER: 4-7 MODEL#(S): 490-58 <br /> DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS a.YES ❑b.NO 490.59 <br /> UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN a.YES ❑b.NO 490-60. <br /> FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. a.YES ❑b.NO 490-61 <br /> UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. ir a.YES ❑b.NO 490.62 <br /> 2.UDC CONSTRUCTION IS;l.SINGLE-WALLED ❑2.DOUBLE-WALLED 4903 <br /> IF DOUBLE WALLED: 490-64a <br /> UDC INTERSTITIAL SPACE IS MONITORED BY: ❑ 1.LIQUID Q2.PRESSURE Q 3.VACUUM <br /> A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a.YES ❑b.NO 490.646 <br /> VII.PERIODIC SYSTEM TESTING <br /> ❑ 1. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490-65. <br /> LEAK DETECTION ELD MUST BE PERFORMED._PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED.(23 CCR§2644.1 — <br /> SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS 490.66 <br /> 3 SPILL BUCKETS ARE TESTED ANNUALLY. 490-67 <br /> VIII.RECORDKEEPING <br /> The following monitoring/maintenance records are kept for this facility: <br /> Alarm logs 490.69a ❑Visual Inspection Records 490-68b ❑Tank integrity testing results 490.680 <br /> SIR testing results(and supporting documentation records). 490-68d ❑ Tank gauging results(and supporting documentation records). 490-68e <br /> ATG Testing results(and supporting documentation records).49MBf ❑ Corrosion Protection 60-day logs 490.68g <br /> Equipment maintenance and calibration records. 490.68h <br /> IX.TRAINING <br /> Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 490-69a <br /> R FERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) <br /> THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)490-69b <br /> OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)490-69C <br /> CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490-69d <br /> ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490-69e <br /> ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND <br /> STATISTICAL INVENTORY RECONCILIATION"490-69f <br /> ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"490-699 <br /> ❑ OTHER(Specify):M69h,M69i <br /> This facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council(ICC). <br /> 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 <br /> training will include,but is not limited to,the following: <br /> ➢ Operation of the UST systems in a manner consistent with the facility's best management practices <br /> ➢ The facility employee's role with regard to the monitoring equipment as specified in this UST Monitoring Plan <br /> ➢ The facility employee's role with regard to spills and overfills as specified in the UST Response Plan <br /> ➢ Names of contact person(s)for emergencies and monitoring alarms.490-70 <br /> X. COMMENTS/ADDITIONAL INFORMATION <br /> Provide additional comments here or indicate how many pages with additional information on specific monitoring procedures are attached to this plan.490-71 <br /> TI-0 - <br /> XI.PERSONNEL RESPONSIBILITIES <br /> 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 <br /> this plan occurs,2)all conditions that indicate a possible release are investigated,and 3)all monitoring records are maintained properly. <br /> The following•person(s)are responsible for rforming the monitoring and equipment mainte ance <br /> NAME�FKWt& I�.'T1 C.. 490.72 TITLE 92R. MA490-73 <br /> NAME 490.74 TITLE 490.75 <br /> 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 <br /> conditions that need follow-up action. <br /> XII.OWNER/OPERATOR SIGNATURE <br /> CE T FICATION:I certify that the information provided herein is true and accurate to the best of my knowledge. <br /> AP CANT S NA RE a 490-76 DATE: 490-77 <br /> ell <br /> T k weer/ ra r 0 2 F ili weer/O rotor ❑3.Authori R r entative f wn r <br /> z AO/ 10 <br /> APPLICANT NAME(print): 490.78 APP CA TITLE: 490-79 <br /> UPCF UST-D(12/2007)3/4 <br />