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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 490.54a <br /> 490.541 <br /> W 1.CONTINUOUS ELECTRONIC MONITORING ❑2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE <br /> ❑4.NO DISPENSERS ❑99.OTHER(Specify): <br /> PANEL MANUFACTURER: L A- 49"5' MODEL#: je C"/ 490-56. <br /> LEAK SENSOR MANUFACTURER: A,;,�,G J1, 490'57 MODEL#(S): `% 'I'_L L 490-58 <br /> DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS 1W a.YES ❑b.NO 490.59 <br /> UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN J@ a.YES ❑b.NO 490.60. <br /> FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. (Y a.YES ❑b.NO 490.61 <br /> UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER ❑ a.YES ❑b.NO 490.62 <br /> 2.UDC CONSTRUCTION IS 0 1.SINGLE-WALLED ❑2.DOUBLE-WALLED 490-63 <br /> IF DOUBLE WALLED: 490-64$ <br /> UDC INTERSTITIAL SPACE IS MONITORED BY: 0 1.LIQUID 2.PRESSURE 3.VACUUM <br /> A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a.YES ❑b.NO 490'641 <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 /> 192.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 /> EgAlarm logs 490.68a ❑Visual Inspection Records 49068b ❑Tank integrity testing results 49°-68, <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).49o-6sr ❑ 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 /> REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) <br /> M THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)490.69b <br /> W'OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)490.69, <br /> ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 49o-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"49Y69g <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.49o-7o <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.49o-71 <br /> U-rr.FC 41,11 Mlye ,f % 1A 9T eF Ftr <br /> M.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 respons'ble for performing the monitoring and equipment maintenappe: <br /> NAME + it '�-L lel L 49o-72 TITLE i d h S c 4=2- 490-73 <br /> NAME 49o.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 /> CERTIFICATION:I certify that the information provided herein is true and accurate to the best of my knowledge. <br /> APPLICANT SIGNATURE 49$76 DATE: 490-77 <br /> REPRESENTING:❑t.Tank QwnedQoerelor O 2.Facility OwnedGoerffior ❑3.Authorized Representative o Owner <br /> APPLICANT NAME(print): 490.78 APPLICANT TITLE: 490-79 <br /> UPCF UST-D(12/2007)3/4 <br />