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0 0 UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) .r 1t�;!5 a s. •x5�unea� �sSwx �v/�}�^� roma � j ri=�'i �!'��✓:1\"� EN �� 4T1® T\`IIG! � I s � k N vx�: _....SMm is-Yfib? ^.. .1 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 490.541, 490-546 1.CONTINUOUS ELECTRONIC MONITORING ❑2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE ❑4.NO DISPENSERS 099.0 R(SPecify): PANEL MANUFACTURER: '490-55 ]MODEL#: a ——--- 490-56. LEAK SENSOR MANUFACTURER: 490-17 MODEL AS): 0?9 q3 . AD 90' 490-58 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 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 Ell.SINGLE-WALLED ❑2.DOUBLE-WALLED 490.63 IF DOUBLE WALLED a90-64a _UDC_INTERSTITIAL SPACE IS MONITORED BY: 0 1.LIQUID El 2.PRESSURE 0 3.VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a.YES ❑b.NO ago-64b r ,," l�i"'jrd�.0 IPPOR -w$- s;z��'W u ��O' � ...r El 1. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490.65. LEAK DETEQUQNELD MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED.(23 CCR 2644.1 ❑2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. _— —_�——_ 490.66 ❑3.SPILL BUCKETS ARE TESTED ANNUALLY. 490.67 ..... 1 .. ]!w"ni —n-u,.. ..,.,a Y+• .....,. "f F'- .. t'hL T um..T._4'lYl.rs nFl �. The following monitoring/maintenance records are kept for this facility: ❑Alarm logs 490-68a ❑Visual Inspection Records 490-68b ❑Tank integrity testing results 490-68c ❑SIR testing results(and supporting documentation records). 490-68d ❑ Tank gauging results(and supporting documentation records). 490-68e ❑ATG Testing results(and supporting documentation records).490-68f ❑ Corrosion Protection 60-day logs 490-68g ❑Equipment maintenance and calibration records. 490-68h Irk dt- ri�'ji {� ' r ss{ `�c"}p47 Y§"S.�,s Y'- 3>= a:. t-fg Axll"�'s�''a �+� i k.- f }fir'` r"'G,..r,, t' s•,.'t ?`!�' c !r Y •3 b� d lye 4 +{ r i �.t rut�y �°{' .ri.".i 3`�,n'.+:`� .� n ,x NTNG ' a'- t• '7 r s N 3j.,-r aa..S.. . i$iut• ❑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 CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490-69d ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 49"% ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND STATISTICAL INVENTORY RECONCILIATION"490-69f ❑ SWRCB PUBLICATION:"UNDERSTANDINC,r AUTOMATIC T1kNK GAUGING SYSTEMS"490-69g f OTHER(Specify):M69h,M69i �r (< 'd 1 e�f M This facility has a"Designated UST Operator"who has passed the California UST Sy9tem 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 emerrgencies and monitoring alarms.490-70 wF � .d?,etf b ^'2* �fidi1 ..1`3' .� ILOlYI1VIU TS{ADDI�'IOL AI. NFO ANON, c-✓u-za' ..+ Provide additional comments here or indicate how many pages with additional information on specific monitoring procedures are attached to this plan.490-71 1I'l EVt I w 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 foliov4N person(s)are responsible for pe ormmg the monitoring and equipment maintenance: NAME U 490-72 TITLE c. 490-73 NAME 49o-74 TITLE 490-75 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. :�� ,y�q�.t� ,v3 r+ �,x-t..ice� �{ `r�' zFc, , w „•.nyn mesio .v� D"Lt ��i /-�,�7� ��, � t� a rr,�y s "�' 'a� CERTIFICATION:I certify that the information provided herein is true and accurate to the best of my knowledge. APP CANT SIGNATURE 490.76 DATE: 490-77 Fuility Ownerftaft R 3.Authofizedt me t0/0 APPLICANT NAME(print): 490-78 APPLICANT TITLE: 490,79 Z Le ss � ® �„ G UPCF UST-D(122007)3/4