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Mar 24 2009 7: 30PM RAMOS OIL S&C 9163713028 p. 5 03/16/2009 MON 7152 FAX 209433 SJC EHD 00041004 (Agemzr Use on(p) 01 Th.s,pltet l cent td: J Approved 0 Approved!With Co dnt el Y,--) Loral Agoucy Signature: Date: Coitntivatts or Special C'.otxlitioaa UST Monitoring Plan--Page 2 Instructions Complete a separate UST Monitoring Plan for each USTmonitoring systetn at the facility, This fonn must be submitted with your initial UST Operating Pennit Application aixl within 30 days of d►anges in the inforination it contains- Please note that your local agtstcy,lnay re(luiiv you to obtain approval prior to installing or modifying inonitoiing equipment. (Note: Numbering of these instructions follows the data element numbers on the form.) 490-54a.MONfrORING OFTHR UNDER DISPENSER CON rAINME"Mr-Indicate tlm method used for UVC monitoring. 490-54b.SPECIFY-I f 99"Otber"is checked,describe other method used, If VI-1-1,VI-1-2or VE-1-3 or VI-1.99ischeekcd,wrrrptcic490-55to490-64b. 490.55. PANEL M ANU FACTU REM-EDIer the write of the martuliacturer of the men 1 lot it%,syslem coul Vol parlel(Console). If there is nocoatro#panel fe.g.,onlyanelectrical relay boy.is installed)leave this space blank. 490.56. MODGL tt- Ender the model number for the monitoring sysictn control panel(console).Ir there is no control panel(e.g.,only on clecirkal relay box is insiallal)leave this space blank. 490-57. iXAKSCNSORMANUFACTURP.ft-Filter thename ofthemanolseluccrofthesonsor(s), 490-58. MODEL i!(S)-Enter tine inodel number of the sensor(s)insWied.If additional space is neede(,use Section X, 490-59. DET'FCTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLr•,AND ViSUAL ALARMS. hu5cate Yes or No 490.61 UAC TXAK ALARM TRIGGER$PUMP SHUTDOWN- 10 ieirtc Yes or No 490.61. FAILURVI)ISCONNECT#ON OF UDC MONITORING SYSTOW"MiGGERS AUTOMATIC PUMP SHUTDOWN-Indicate Yes or No 490.62. UDC MONITORING STOPS T)IE FLOW OF PRODUCT AT Tllu.D#SPENSIiit-Indicate Yes or No. 490.63. UDC CONSTRUCTION'- indicate if the consnuctiont of the UPC is single-waIlect,or double-wall ed. 490-64a.DO4)ALG-WAI.LhD INTERS'I'fl'IAI,SPA(:F MONrMItiNG- Indicate what is used to inenilor the interstitial space, 490.64b.LEAK WITIiINI'#IG REMNDARY C014'fAIMI:N'1'OI'(IDC TRIGGERS AUDIBLE AND ViSUAL.ALARMS-Indicate Yes or No 490-65. VII-I 1•-l.D TESTING-Check firebox ifyoulravebeen notified by the State Waver Resources Conhtat Bond(SWRCB)that the UST(s)covered by this plan is/aro subject to Enhanced Leak Detection Requirements(i.e.,USI'has any single-wall eorttponemt and is located within'.,000 feet of a public drinking water well). 490.66. TESTING OF SECONDARY CONTAINMENT COMPONENTS EVG12Y 3,6 uoNrmS-Check the box if yeti have secondary containment Ihat requites testing. 490-67. SPILL BUCKET TESTING-Clieck the box it'you have spill buckem 490-68a-h,VIII RFCORDI(EEPING-indicate which monitoring and equipment mrainicnance,records are mainained for this tbeilily, 490-69a IX TRAINING SrXfEMCNT-Check the bine to verily that thestatenuml is true. REFERENCE DOCUMENTS MAINTAIN M- Al'FACILI TY-Check the appropriate boxes to describe reference documents maintainedi at the facility. Note that the fust two items on the list most be kept at the facility. 490-69b.MONITORING PIAN:Indicate that this pian is kept as a reference docunicnt. 490-691, OPERATING MANUALS FOR ELECTRONIC EQUIPMEMI':Indicate that this plan is kept as a refemnee doutment. 490.69d. CA UST REGULATIONS-Indicate that this is kept as a reference document. 490.691, CA UST LAW-Indicate that this is kept as a reference document. d.90-69f STAT&WATER RESOURCES CONTROL BOARD(SWRCB)PUBLICATION-"HANDBOOK FOR TANK OWNERS-MANUAL AND STATISTICAL INVENTORY RECONCILIATION-Indicate that this is kept as a referoneo document. 490-69g.SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS":Indicatethat this is kept as a retbrencodoacntcat. 490.49h.OTHER-Inrlicaletheit other reterence documents arekedx. 490-49i. SPECIFY-If"OTHER"is chocked,entora briefdescription orlho ollserdocument(s)maimained at the Paei6ty.if additional space is needed,sac Section X, 490-70. DESIGNATED OPERATOR TRAINING-Check Ihisbox to verify that this statement isttue. 490-71. COMMENTSIADDITIONALINFORMATION-Makeadditionalcommentsorymmayouadtandidertifythenumberofadditionalpagesofinfonnationtodescribe any additional[1ST systetn monitoring-related information(e.y,adtlitional inlbTrowion required by your local agency). Attach any monitoring togs that you will be using for the monitoring of your tank system. 490.72, NAM 1-1-Enter lite name of the person who routinely conducts the monitoring and equipment maintenance under this plan. 490-73. TiTiB- Enter lite rine of the person. 490-74. NAME-Eviler the name of lite second poison,i IF app iicable,who rdulinely con(hicts the monitoring and equipmentmainlatanceuWarthisplan. 490-75. TIT11- Eviler the title of the second person. OW NE VOPERNI'OR SIGNATURE-The lauk owner/operator,facility owner/opetator,or an atthorimd representative o f the owner$ball sigu in the spa cc lmovided. This signature cenifics that the signer believes that all infonnatian submitted is true,accurate,and cotrg*W and that the Draining lmrCiam specified in Section IX has been implemented. 490-76. ItEPRFSENIING--Check the appropriate lox to indicate tvhether tho signer•is the tiSr owner/operaum,the 11ST facility ownerloperalor,or an authorized representative of the owner. 490.77. DATE-Crater the date the plan was signed. 490-78. APP(JCANT NAME-Print or type the name of Ile pccwn signing the plan. 490-79. APPL.ICANTTfTL11-Il,nterthe Iitic0Fthe penonsign inll the plan. UPCF LUST-D(1212)07)414