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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) VL UNDER DISPENSER CONTAINMENT(UDC)MONITORING 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 490-541 4901546b AI.CONTINUOUS ELECTRONIC MONITORING 0 2.FLOAT AND CHAIN ASSEMBLY 0 3.ELECTRONIC STAND-ALONE 0 4,NO DISPENSERS 099.OTHER(Specify): 490-5- 4W56. PANEL MANUFACTURER: MODEL#: LEAK SENSOR MANUFACTURER: 496:57 MODEL#(S): 490-58 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS 0 a-YES U10b.NO 490-59 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN a] a.YES Ob.NO 490-60. FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. J4 a.YES ❑b.NO 490-61 UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. do a.YES ❑b.NO 490-62 2.UDC CONSTRUCTION IS L.SINGLE-WALLED 0 2.DOUBLE-WALLED 49"3 IF DOUBLE WALLED: 490-648 UDC INTERSTITIAL SPACE IS MONITORED BY: [11.LIQUID 0 2.PRESSURE El 3,VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS YES 1:3b.NO 49-646 VII.PERIODIC SYSTEM TESTING 0 1. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490-65 LEAK DET ECjjaNLEIDFORMED. PERIODIC ELD IS PERFORMED EVERY f6 MONTHS AS REQUIRED.(23 CCR§2644.1) j MUST BE PEP 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490-66 P91.SPILL BUCKETS ARE TESTED ANNUALLY 490-67 VIII.RECORDKEEPING The following monitoring/maintenance records are kept for this facility: aAlarm logs 490-6& .Visual Inspection Records 490-6ab Tank integrity testing results 4906 •SIR testing results(and supporting documentation records). 49484 0 Tank gauging results(and supporting documentation records). ago-6&e •ATG Testing results(and supporting documentation records).4%-6sf 0 Corrosion Protection 60-day logs 4%-688 �KEqyipment maintenance and calibration records. 490-68h IX.TRAINING JjArersonnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 40.M% 'REFERENCE DOCUMENTS MAINTAINED AT FACILITY(Check all that apply) THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)490-696 OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)490.69c f-1 CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 4g-69d 0 CALIFORNIA UNDERGROUND STORAGE TANK LAW 49"% F1 STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION'49-696 rl SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"490-698 ❑ OTHER(Specify):m6gh,w% &rThis facility.has-a.."Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council([CC). We"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 LIST 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 LIST Response Plan • Names of contact person(s)for emergencies and monitoring alarms.4w7o 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.4go-7i 70 AVII -/-*/- XL PERSONNEL RESMNSIBILITIES 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 followinWrson(s)are reTonsible for performin the Monitoring and equipment maintc11= , ,,.- NAME jr;g�2�� 48-72 TITLE 490-73 NAME gfg�. 49o-74 TITLE r-,Mr— 490-75 The Designpokd O&rat&r s perf6fin a mthK visual inspection of the facility,provide v[report to the owner/operator,and inform the owner/operator of any conditions that need follow-up action. Yy(j OWNER/OPERATOR SIGNATURE CERTIFICATION:ISertify that the inffirmatio/r/ovided herein is true and accurate to the best of My knowledge. A PPLIC SIGNA M 491,71 DATE: 490-77 N.= ank OwnedO�tort 3 APPLICANT NAME(print)- 4111*78 1 APPLI LE: 496 79 APPLICANT NAME UPCF UST-D(1212007)314