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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN-(Page 2 of 2 VI. UNDER DISPENSER CONTAINMENT(UDC)MONITORING (Check all that apply) UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) ® 1.CONTINUOUS ELECTRONIC MONITORING ❑ 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE 490-54a. ❑ 4.NO DISPENSERS ❑ 99.OTHER(S eci 490-sab. .. ... ...... ...... ................_................................................................._......._.........._.... .)..........................................................................................._............................................................_. _................................. ................................................b....... LEAK MONITOR MANUFACTURER:Veeder-Root 990-5s. MODEL#:TLS-350 ago-s6. LEAK SENSOR MANUFACTURER: Veeder-Root 490-57. MODEL#(S):Liquid Sensor Series 794380-208 490-58. 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 '9'-'0- 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. .. ... ... .......................................................... UDC CONSTRUCTION IS: ® 1.SINGLE WALL ❑ 2.DOUBLE WALL 490-63. IF DOUBLE WALL: 490-64a. -UDC INTERSTITIAL SPACE IS MONITORED BY: ❑ a.LIQUID ❑ b.PRESSURE ❑ c.VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. ❑ a.YES ❑ b.NO 490-64b. VII. PERIODIC SYSTEM TESTING ❑ 1.ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490-65. K DETECTIONAELD MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED.123 CCR§2644.11 CONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490-66, 3.SPILL BUCKETS ARE TESTED ANNUALLY. 490-67. VIII. RECORD KEEPING The following monitoring/maintenance records are kept for this facility: 490-W ® a.ALARM LOGS ❑ b.VISUAL INSPECTION RECORDS ❑ c.TANK INTEGRITY TESTING RESULTS ❑ d.SIR TESTING RESULTS(and supporting documentation records) ❑ e.TANK GAUGING RESULTS(and supporting documentation records) ❑ f.ATG TESTING RESULTS(and supporting documentation records) ❑ g.CORROSION PROTECTION 60-DAY LOGS ® h.EQUIPMENT MAINTENANCE AND CALIBRATION RECORDS IX• TRAINING ® 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 490-69e. ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND 490-69f. STATISTICAL INVENTORY RECONCILIATION" ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 490-69g. ® This facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council 490-70. (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 facility's UST Response Plan. ➢ Name(s)of contact person(s)for emergencies and monitoring alarms. 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. • UST TURBINE&FILL SUMP MONITORING: PANEL MANUFACTURER: Veeder-Root MODEL TLS-350 LEAK SENSOR MANUFACTURER:Veeder-Root MODEL#(S):Liquid Sensor Series 794380-208 • AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR DOUBLE WALL TANK(S) PANEL MANUFACTURER: Veeder-Root MODEL#: TLS-350 IN-TANK PROBE MANUFACTURER Veeder-Root MODEL#: MAG 1 • OVERFILL PREVENTION METHOD:FILL TUBE SHUT OFF VALVE OPW 61-SO-PT(�95% • EVR ISD Software Installed 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 b this plan occurs;2.)all conditions that indicate a possible release are investigated;and 3. all monitoringrecords are maintained ro erl . ... ...................................................................... ........................._....................................._.............P.....�........Y._..............._.._..._......._........................................................ Y................ ...._............................_........................................._................._.......--._.............._.... _....._..........................................__............................... THE FOLLOW E RESPONSIB�FORPERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE: N 490-72. TITLE:Manager: 490-73. NAME: 490-74. TITLE:Asst Manager: 490-75. The Designated:J=Wator shall perform a onthly visual inspection of the facility,provide a report to the owner/operator,and inform the owner/operator of any condflous that need follow-up action. I. OWNER/OPERATOR SIGNATURE CERTIFICATION:I certify that the in in do rovide erein is true and accurate to the best of my knowledge. APPLICANT SIGNATURE DATE: 490-77. REPRESENTING:®1.Tank Owner/Operator❑2.Facili O ner rator❑3.Authorized Representative of Owner 490-76. 06/12/2009 APPLICANT NAME(print): 490-78. APPLICANT TITLE: 490-79. Chevron Products Co./JIM HARM N Chevron Retail HES Permit Desk (Agency use only) This form has beennevi a and: Approved E] Approved with Conditions❑ Disapproved❑ Local Agency Signature: Date: