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a A& "UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN (Page 2 of 2) VI.UNDER DISPENSER CONTAINMENT(UDC)MONITORING 490-54a 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 490-54b 1.CONTINUOUS ELECTRONIC MONITORING F1 2.FLOAT AND CHAIN ASSEMBLY El 3.ELECTRONIC STAND-ALONE E]4.NO DISPENSERS 099.OTHER(Specify): ago-s5 i MODEL-# ------------------------- 490-56. PANEL MANUFACTURER: –--------- -R1 1 0- ------–-------- ------------–-–-–-—------- ------ -�i I :-----twl -_ : _71�i ------—------------–--��6_ LEAK SENSOR MANUFACTURER: Ve4V_7jL gooT 1 MODEL#(S): 11 DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS 2 a.YES El b.NO 490-59 UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN 9 a.YES F1 b.NO 490-60. FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. a.YES M b,NO 490-61 UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. a.YES F]b.NO 490-62 490-63 2.UDC CONSTRUCTION IS 1.SINGLE-WALLED E32.DOUBLE-WALLED ------------- 490-64a IF DOUBLE WALLED: UDC INTERSTITIAL SPACE IS MONITORED BY: El 1.LIQUID Ot 2.PRESSURE 0 3.VACUUM -------–----–----------–------------------------- ------YA ALARMS El a.YES El b.NO 490-64b A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL A VII.PERIODIC SYSTEM TESTING r_1 1. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490-65. LEAK DETECTION(ELD)MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. CCR_§�644 I ---------- -AS_REQUIRED.–-------- -----I)------------- -------—--- --- 490-66 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. -–------------–----–---–-------–----–--------------------------------------------- 3.SPILL BiUe_1dT§akf_yKSTED ANNUALLY. 490-67 VIII.RECORDKEEPING The following monitoring/maintenance records are kept for this facility: ®'Alarm logs 490-68a R Visual Inspection Records 490-68b ❑Tank integrity testing results 490-68c 0 SIR testing results(and supporting documentation records). 490-68d ❑ Tank gauging results(and supporting documentation records). 490-68e [I ATG Testing results(and supporting documentation records).490-68f ❑ Corrosion Protection 60-day logs 490-68g El Equipment maintenance and calibration records. 490-68h IX.TRAINING 09 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) IM THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)490-69b CN OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)490-69c 0 CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490-69d E] CALIFORNIA UNDERGROUND STORAGE TANK LAW 490-69e ❑ 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"490-69g ❑ OTHER(Specify):M69h,M69i nal Code Council(ICC). fig This facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the Intematio 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 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.490-71 k6XANkGJ 0JeAA011J CO-NIs, of q!40 XI.PERSONNEL RESPONSIBILITIES 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 followl sible for performing the monitoring and equipment maiinten IVA 490-73 . NAME KI A TJ,C1(L 490-72 TITLE _1SL fvk lint 490-75 –NAME kjCV%&JkX_ 14, 490-74 TITLE AINA; n!&ACC 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. XIL OWNER/OPERATOR SIGNATURE CERTIFICATION:I certify that the information provided herein is true and accurate to the best of my knowledge. 490-77 APPLICANT SIM TU 490-76 DATE: I k gEPRESENTINQ1. 1.Tank 0 e rator 2.Facility 0wner/Q- 490-78 TITLE: 490-79 APPLICANT NAME print): APPLICANT -4 D 44W JAW-9-9 UPCF UST-D(12/2007)3/4