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• UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN — (Page 2 of 2 VI. UNDER DISPENSER CONTAINMENT (UDC) MONITORING hat that 1 apply) UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) I CONTINUOUS ELECTRONIC MONITORING ❑ 2 FLOAT AND CHAIN ASSEMBLY ❑ 3 ELECTRONIC STAND-ALONE 490-546 ❑ 4. NO DISPENSERS ❑ 99. OTHER (S ecify) LEAK MONITOR MANUFACTURER: wagrR` - 41 -ss MODEL #: 490-54b 49656 49657 MODEL #(S): 96,S LEAK SENSOR MANUFACTURER: y OAer T<WV 490-511 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑ a. YES ❑ b NO 490-59 UDC LEAK ALARM TRIGGERS AUIOMATIC PUMP SHUIDOWN ❑ a YES ❑ b. NO 490-60 FAILURE/DISCONNECTION OF UDC MONIIORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN ❑ a YES ❑ b NO 490-61 UDC MONITORING STOPS THE FLOW OF PRODUCT AT IHE DISPENSER [Ia. YES ❑ b NO 490-62 UDC CONSTRUCTION IS: 1 SINGLE WALL ❑ 2 DOUBLE WALL 490-63 IF DOUBLE WALL: 490.64a UDC INTERSTITIAL SPACE IS MONITORED BY: ❑ a LIQUID ❑ b PRESSURE ❑ c VACUUM A LEAK WITHIN THE SECONDARY CONIAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ❑ a. YES ❑ b. NO 490.641 VII. PERIODIC SYSTEM TESTING' ❑ I ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490-65 LEAK DETECTION MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. f23 CCR §2644.1] ® 2. SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490-66 ® 3. SPILL BUCKETS ARE TESTED ANNUALLY. 490-67 VIII. RECORD KEEPING The following monitoring/maintenance records are kept for this facility: 49669 ® a ALARM LOGS M b VISUAL INSPECTION RECORDS ❑ c TANK INIEGRITY 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 CALIBRAIION RECORDS IX TRAINING ® Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties: 490-69a 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) 490-69c �j CALIFORNIA UNDERGROUND STORAGE IANK REGULAIIONS 490-69d C1 CALIFORNIA UNDERGROUND STORAGE TANK LAW 490-69e ® STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR IANK OWNERS - MANUAL AND 49669f STATISTICAL INVENTORY RECONCILIATION" SWRCB PUBLICATION: "UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 490-69g [3OTHER (Specify): 490.69h 490-69i. ® This facility has a "Designated UST Operator" who has passed the California 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 USI Response Plan. ➢ Name(s) of contact person(s) for emergencies and monitoring alarms X. COMMENTS/ADDITIONAL INFORMATION Provide additional comments here or indicate how many pages with additional information on specific monitoring procedures are attached to this plan 490-71 XI. PERSONNEL RESPONSIBILITIES The UST Owner/Operator is responsible for ensuring that: I ) the daily/routine UST monitoring activities and maintenance of UST leak detection equipment covered by this plan occurs. 2) all conditions that indicate apossible release are investigated; and.3 ) all monitoring records are maintained prg2SOy. - .__.. THE FOLLOWING PERSON(S) ARE RESPONSIBLE FOR PERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE: NAME: TWV(— 490.72 TITLE: 490.73 NAME: eCgoice490.74 TITLE: A6& 49675 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. XIL OWNER/OPERATOR SIGNATURE CERTIFICATION: I r1ify tha e-ijifortnafi provid ein is true and accurate to the best of my knowledge. APPLICANT SIGNATURE DATE: 490-77 / ^` REPRESENTING: ❑ 1. Tank Owner rator ❑ 2. Fa i weer/ erator 3. Authorized Re resentative of Owner 490-76. APPLICANT NAME (print)- 49°-7s SAk APPLICANT TITLE: /1 ��§ IMclv�a 2►'o 1t��o a9°a9 . i0�vi 1st ►I IQts't�. UPCF UST -D (12/2007) -3/4 www.unidocs.org