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IFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) 77 /trx � 3 a7-7777 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 490-54e '❑ 1.CONTINUOUS ELECTRONIC MONITORING ®2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE 490-54b ❑4.NO DISPENSERS E199.OTHER(Specify): PANEL MANUFACTURER: 490-55 MODEL#: 490-56. LEAK SENSOR MANUFACTURER:Bravo Boa 490-57 i MODEL#(S):Unknown 490-58 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑ -YES ®b.NO 49-59 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 490-6] UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. ® a.YES ❑b.NO 490-62 2.UDC CONSTRUCTION IS ®1.SINGLE-WALLED ❑2.DOUBLE-WALLED 490-63 IF DOUBLE WALLED: 490-64a UDC INTERSTITIAL SPACE IS MONITORED BY: ❑ L LIQUID [12.PRESSURE [13.VACUUM ------------ A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a YES ❑b NO _ ., k 490-64b ❑ 1. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCEDago ss. LEAK DETECTION(ELD MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED.(23 CCR2644 ®2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490-66 ®3.SPILL BUCKETS ARE TESTED ANNUALLY. 490-67 The following monitoring/maintenance records are kept for this facility: ®Alar logs ago-baa ❑Visual Inspection Records 49"sb ❑Tank integrity testing results 490-68. ❑SIR testing results(and supporting documentation records). 4ga68d ❑ Tank gauging results(and supporting documentation records). 4go-6se ❑ATG Testing results(and supporting documentation records).4go-68f ❑ Corrosion Protection 60-day logs 490-654 ❑Equipment maintenance and calibration records. 490-68h ®Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 4go-694 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)4go-69c ® CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490-69d ® CALIFORNIA UNDERGROUND STORAGE TANK LAW 490.6% ® STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION"490-69f ® SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"490-695 ❑ OTHER(Specify):M6gh,M6gi ®This facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council(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 UST Response Plan ➢ Names of contact person(s)for emergencies and monitoring alarms.490-70 Provide Overfillprotection comments here or indicate now man es with additional information � �` Y P� � � ration on specific monitoring procedures are attached to this plan.aga7t p on is provided by a flapper assembly in the drop tubes that restrict flow when the liquid level reaches 95%of the UST's capacity. - . 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 this plan occurs,2)all conditions that indicate a possible release are investigated,and 3)all monitoring records are maintained properly. The following person(s)are responsible for performing the monitoring and equipment maintenance: NAME o 48-72 TITLE NAME 44474 TITLE 440-73 49-75 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 conditions that need follow-up action. CERTIFICATION.I certify that a information provided hereinis true and accurate to thebest of my knowledge. _ APPL�T SI A P 490-76 DATE: agar ator 3.Autbo' R o e f APPLICAN AME(print): 4W78 APPLICANT TIT 490-79 UPCF UST-D(12/2007)3/4