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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) VI?UNDE1t DISPENSER CONTAINMEV T,((75C�1NONITURING '; 1. UPC—MONITORING IS PERFORMED USING THE FOLLOWING METHOD 490-548 490.54b I,CONTINUOUS ELECTRONIC MONITORING [12.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE ❑4.NO DISPENSERS E199.OTHER(S ci ): _ PANEL MANUFACTURER: �,q� — ago-ss MODEL#: F — v v — 490-56. --------- - -V 1?---- -- - - -- - ---- ------ - LEAK SENSOR MANUFACTURER: rr""— a90 57 MODEL#(S) V 0 490-s0- 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 of a•YES ❑b.NO 490-60. FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. a.YES ❑b.NO 490.61 UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER, a.YES ❑b.NO 490-62 2.UDC CONSTRUCTION IS -SINGLE-WALLED 02-DOUBLE-WALLED 490-65 IF DOUBLE WALLED: `� 490•-64a _ UDC INTERSTITIAL SPACE IS MONITORED BY: LIQUID 0 2.—PRESSURE 0 3,VACUUM—---------- A -- — ------------- A LEAK WITHIN THE SECONDARY CONTAINM OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a.YES ❑b.NO 490-64b V7X I! IiTOU[C SYSTENf'TEST[1� ....:.. ❑ 1. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490-65. _ LEAK TION(ELD)MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY_36 MONTHS AS REOUIRED_(23 CCR§264.4_.1) ---_-_ 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490-66 SPILL BUCKETS ARE TESTED ANNUALLY. 490-67 YIII RECORDKEPINO.' Th (lowing monitoring/mai5iinThce records are kept for this facility: (Alarm logs 490-691L 531visual Inspection Records 490-68b ❑Tank integrity testing results 490-680 rArGsting results(and upporting documentation records)- 490-69d ❑ Tank gauging results(and supporting documentation records). 490.680 Testingresults(and supporting documentation records).490.6af ❑ Corrosion Protection 60-day logs 490-ag ment maintenance and calibration records. 490-6sh ;TRAININ+G ❑Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 490.693 REFER.ENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) W_THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)490.69b OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)490-69c CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 49MW ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 49069e ❑ STATE WATER RESOURCES CONTROL BOARD (S ) PUBLICATION: "HANDBOOK FOR TANK OWNERS MANUAL AND STATISTICAL INVENTORY RECONCILIATION"4 -69f ❑ S RCB PUBLICATION:"UNDERSTANDING AUT MATIC TANK GAUGING SYSTEMS"490-69g JJ�OTHER(Specify):Wh,M69i This facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council(ICC). e"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 PIan Y The facility employee's role with regard to spills and overfills as specified in the UST Response Plan r ➢ Names of contact person(s)for emergencies and monitoring alarms 490-70 X COMMENTSlADDTONAL INFOR1y1ATION rovide a _ ..::. dditional comments here or indicate how many pages with additional information on specific monitoring procedures are attached to this plan.490.7 XI PERSO NNEX,;RESPr3NSIBIliITTE$ 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 followin rson(s) a resp 'ble for performing the monitoring and equipment ma intenanc / NAME �0 (� �� e!_ 49o.72 TITLE 490-75 NAME --- tc� 490-74 TITLE 0-90-75 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. wio CERTIFICATION:l i that the info ion providgffherein is true and accurate to the best of my know)edge. RE 490-76 DATE: 490-77 E n. Tank Own rl F iii wn � APPLICANT NAME(print): 490-7 L NT 1TLE: �r UPCF UST-D(12/2007)314 r