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Ah <br /> NIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANK <br /> MONITORING PLAN (Page 2 of 2) <br /> VI.UNDER DISPENSER CONTAINMENT(UDC)MONITORING <br /> 1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 490-54490-54b <br /> ® 1.CONTINUOUS ELECTRONIC MONITORING ❑ 2.FLOAT AND CHAIN ASSEMBLY ❑ 3.ELECTRONIC STAND-ALONE <br /> ❑ 4.NO DISPENSERS _❑99.OTHER(Sp_cify)M <br /> _PANEL MANUFACTURER: _ Veeder Root 490-55 MODEL#: TLS-350 490-56. <br /> LEAK SENSOR MANUFACTURER: Veeder Root _ M 49°-57 MODEL#(S): 794380-208 490-58 <br /> DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ® a.YES ❑b.NO 490-59 <br /> UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN ® a.YES ❑b.NO 490-60. <br /> FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ® a.YES ❑b.NO 490-61 <br /> UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. ❑ a.YES ®b.NO 490-62 <br /> 2.UDC CONSTRUCTION IS ®1.SINGLE-WALLED ❑ 2.DOUBLE-WALLED 490-63 <br /> IF DOUBLE WALLED: 490-64a <br /> UDC INTERSTITIAL SPACE IS MONITORED BY: ❑ 1.LIQUID [12.PRESSURE El 3.VACUUM <br /> A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS ❑a.YES ❑b.NO 490-64b <br /> VII.PERIODIC SYSTEM TESTING <br /> ❑ 1. ELD TESTING: THIS FACILITY HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 490-65. <br /> _ LEAK DETECTION ELD MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REsUIRED. 23 CCR 2644.1 <br /> ^-----_.. .. .� _ <br /> ®2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490-66 <br /> ®3.SPILL BUCKETS ARE TESTED ANNUALLY. 490-67 <br /> VIII.RECORDKEEPING <br /> The following monitoring/maintenance records are kept for this facility: <br /> ®Alarm logs 490-68a ❑Visual Inspection Records 490-68b ❑Tank integrity testing results 490-68c <br /> ❑SIR testing results(and supporting documentation records). 490-68d ❑ Tank gauging results(and supporting documentation records). 490-68e <br /> ❑ATG Testing results(and supporting documentation records).490-68f ❑ Corrosion Protection 60-day logs 490-68g <br /> ®Equipment maintenance and calibration records. 490-68h <br /> IX.TRAINING <br /> ®Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 490-69a <br /> REFERENCE DOCUMENTS MAINTAINED AT FACILITY❑(Check all that apply) <br /> ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required)490-69b <br /> ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT(Required)490-690 <br /> ❑ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 490-69d <br /> ❑ CALIFORNIA UNDERGROUND STORAGE TANK LAW 490-69e <br /> ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND <br /> STATISTICAL INVENTORY RECONCILIATION"490-69f <br /> ❑ SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS"490-69g <br /> ❑ OTHER(Specify):M69h,M69i <br /> ®This facility has a"Designated UST Operator"who has passed the California UST System Operator Exam administered by the International Code Council(ICC). <br /> 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 <br /> training will include,but is not limited to,the following: <br /> ➢ Operation of the UST systems in a manner consistent with the facility's best management practices <br /> ➢ The facility employee's role with regard to the monitoring equipment as specified in this UST Monitoring Plan <br /> ➢ The facility employee's role with regard to spills and overfills as specified in the UST Response Plan <br /> ➢ Names of contact person(s)for emergencies and monitoring alarms.490-70 <br /> X. COMMENTS/ADDITIONAL INFORMATION <br /> Provide additional comments here or indicate how many pages with additional information on specific monitoring procedures are attached to this plan.490-71 <br /> There is a Mechanical Overfill device installed on this system set at 95%of capacity. <br /> Sump Sensor-Transition 1,#794380-322 Transition 2#794380-352 <br /> XI.PERSONNEL RESPONSIBILITIES <br /> 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 <br /> this plan occurs,2)all conditions that indicate a possible release are investigated,and 3)all monitoring records are maintained properly. <br /> The following person(s)are responsible for performing the monitoring and equipment maintenance: <br /> NAME Jose Jimenez 490-72 TITLE General Manager 490.73 <br /> NAME Joey Cupp 490-74 TITLE Environmental Mgr 490-75 <br /> 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 <br /> conditions that need follow-up action. <br /> XIL OWNER/OPERATOR SIGNATURE <br /> CERTIFICATION:I certify that the information provided herein is true and accurate to the best of my knowledge. <br /> APPLICA 490-76 DATE: o-n <br /> April 10,2012 ° <br /> N 1. ��_Iggatorner/O ❑3.Authorized Re resentatne of can r <br /> AP ICANT NAME(print): 490-78 APPLICANT TITLE: 4 -79 <br /> Joey Cupp Environment Management <br /> UPCF UST-D(12/2007)2/6 <br />