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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN—(Page 2 of 2 7Checkall VI.UNDER DISPENSER CONTAMMENT(UDQ MONITORING thatamlye, UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) 1.CONTINUOUS ELECTRONIC molsirromo [1 2.FLOAT AND CHAIN ASSEMBLY [1 3.ELECTRONIC STAND-ALONE 4W54a. ❑ 4.NO DISPENSERS0 99.OTHER(Specify) 4W54h .................................................. ..........--..................................... LEAK MONITOR MANUFACTURER.VEEDER-ROOTIOMNTEC 191-11- MODEL ti TLS-3601800011 490.56. LEAK SENSOR MANUFACTURER.VEEDER-ROOT 490-57, MODEL As):352 4W58. DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. N a YES El b.NO 490"59. UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN. 0 a.YES 0 b.NO 490-0- FAILUREIDISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ED a.YES [I b.NO 490.61. UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. 0 a.YES El b.NO 490-62- .................... ...........................---.................................................................................... ...........--..................................................--.---------........................................................................................................................................ UDC CONSTRUCTION IS: n I SINGLE WALL [J 2.DOUBLE WALL 490-63. IF DOUBLE WALL. 490-648. UDC INTERSTITIAL SPACE IS MONITORED BY [I a.LIQUID ❑ b.PRESSURE ❑ c.VACUUM A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. [I a.YES El b.NO 49M4b. VII. PERIODIC SYSTEM TESTING El I N5 TESTING:THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490-65. LA&K P-1,zJ—EU-1-QN(ELM MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED.t23 CCR 02644.11 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490-66. 3.SPELL BUCKETS ARE TESTED ANNUALLY. 490-67. VIIL RECORD KEEPING The following monkoring/maintenme records are kept for this facility: 490-69. 0 a.ALARM LOGS [3 b.VISUAL INSPECTION RECORDS 0 c.TANK INTEGRITY TESTING RESULTS 0 d.SIR TESTING RESULTS(and supporting documentation records) [:1 e.TANK GAUGING RESULTS(and supporting documentation records) 0 f ATG TESTING RESULTS(and supporting documentation records) [I g.CORROSION PROTECTION 60-DAY LOGS 0 h.EQ111PMENT MAINTENANCE AND CALIBRATION RECORDS IDL TRAINING M 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) N THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) 490-69b. 0 OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required) 490-69- 0 CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490-69d ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490-690- ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION "HANDBOOK FOR TANK OWNERS MANUAL AND 490-69E STATISTICAL INVENTORY RECONCILIATION" ❑ SWRCEI PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 490-69g. OTHER(Specify): 490-69h. 490-69L N 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 mainteamce of the UST system 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 COAUM"NTS/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. XJ. IF`RRSQNNn RESPONSIBMITIES The UST Owner/Openitor is responsible for ensuring that:1.)the dailyhoutine UST monitoring activities and maintenance of UST leak detection equipment covered -kthis plan. conditionsthat j A�P.o . -11-..-................- THE FOLLOWING PERSON(S)ARE RESPONSIBLE FOR PERFORMING THE MONITORING AND EQUIPMENT MAINTENANCE: NAME: rArA hvr,l—, 'w". TITLE:GENERAL MANAGER 490-73. NAME: PAUL RIGGS 490-74- TITLE:-D1tT—R1CT MANAGER V 490-75. The Designated UST 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 followL-u action. 3UL OWNER/OPERATOR SIGNATURE CERTIFICATION:I certify that the Information provided herein is true and accurate to the best of my knowledge. APPLICANT SIGNATURE DATE: 490-TT REPRESENTING:C]I.Trak OwnaZ;;;W—t3i:Mt:iU;n-&OPa�,to,C)3.Authorized&pemtati,eof0. 490-76a APPLICANT NAME(print): 490-78. 4W79. APPLICANT TITLE: JEFFLARSEN DIRECTOR OF HSE UPCF UST-D(12/2007)-3/4 www.unidocs.org