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TWIFIED PROGRAM CONSOLIDATED FORM- UNDERGROUND STORAGE TANK MONITORING PLAN 2 of 2) . t V i .:3: ek {A:: r R`: .x 1. UDC MONITORING IS F USING THE FOLLOWING METHOD 4W54" ❑ 1.CONTINUOUS ELECTRONIC MONITORING DQ 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE ❑4.NO DISPENSERS ❑99.OTHM(S PANEL MANUFACTURER. 490•S5 MODEL# 490 s6. LEAK SENSOR MANUFACTURER. 490.57 MODEL#(S): 490-59 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 49a61 UDC MONITORING STOPS THE FLAW OF PRODUCT AT THE DISPENSER. a.YES ❑b.NO 49042 2.UDC COMMUCTION IS 1.SINGLE-WALLED ❑2. -WALLED 3 IF DOUBLE WALLED: 490.646 UDC mTERSTTTLAL SPACE IS MONITORED BY 1.LI UID 02.PRESSURE 03.VACUUM A LEAK WITIM THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a YES ❑b.NO 49066 .. .. V . 7777 1.ELD G.THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THATEN FAD 49"5. RgMMOM MUST BE PERFORMED. PERIODIC Eli)IS PERFORMED EVERY 36 MONTHS AS REQUIRED. 23 CCR 644.1 0 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 4 90-66 3.SPILL BUCKET'S ARE ANNUALLY. 490-67 The fol g/,.• records me kept for this fiscilitr. AI ®Vimud Inspection Records 490.6sb ❑Tank mtegrity testing results 49o•6sc ❑SIR (mut documentation records). 490.6aa 13 Tank (and ' records). 490 6so ❑ATG Testing (and supporting documentation ).49m-6sr ❑ Corrosion logs ❑Equipment makinance and calibration records. 490-M Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to thea,lob duty. 490 6 REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that Wly) ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)490-8b OPERATING MANUALS FOR ELECTRONIC MONITORING EQ ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS ❑ CALIFORNIAUNDERGROUND STORAGE TANK LAW 49o*% ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS MANUAL AND STATISTICAL INVENTORY RECONCILIATION"490-W [� SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" OTHER(Specify):w9hma This facility has a"Designated UST who has passed the Calilbruia UST System Operator Exam administered by the InUmational Co&Council(ICC). The"Designated UST will train facility employees in the proper operation and maintenance of die UST system annually,and within 30 days of hire.This training will include,bort is not limited to,the following: D Operation of the UST systems in a marmor consistent with the facility's bed management practices A The fasrWV 's role with regard to the monitoring equipment as specified in this UST Monitoring Pin A The ficility employees rola with regard to spills and overfills as specified in the UST Response Plan O> Names of s)for emergencies mut monitoring 21MM.490-70 f ..a NRMA z "x .t_ h .✓i, vt Provide addition ai crormneahts how or indicate how mmhypages w}Ii dadditi°aa�l,'n ( onspacife monitoringPS> }u as are Thai to this pini 49a7t 2r f 14l (,�f8t/NN `I � �19ni 77 The UST Owner is responsible for encoring that-I)the daily/mutiec,UST manitwimg activities and romehtenanae of UST leak detection equipment covered by this pian occurs,2)all conditions that indicate a possible release are investigated,and 3)all moriite ft records are maintained property The s)are responsible for performing the mai mid equipment maintenance: NAME S !LaMar o&72 TITLE Stere MEMO 490.73 NAM Kan Cain 490-74 I= Dowd Manager 490-73 The Designated Operator shall perform a monthly visual'inspection of the&a*,provide a report to the owriadoperator,and inform the owner/operator of any conditions that hid follow-up achom �y CERTIFICATION:I certify tfid the info 'on provided herein is true and accurate to the best of nry knowledge, APPLICANT SIGNATURE 490-76 DATE. 490-T7 5/6/08 APPLICANT NAME ): APPLICANT TITLE- 4%179 Stephen Boyd HSE Specialist UPCF UST-D(t 3/4