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SAN JOAQ COUNTY ENVIRONMENTAL HEALTH ARTMENT <br />UNDERGROUND STORAGE TANK <br />MONITORING PLAN - PAGE 1 <br />TYPE OF ACTION ❑ 1. NEW PLAN 0 2. CHANGE OF INFORMATION <br />M81. <br />PLAN TYPE ® MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. <br />Mcz. <br />(Check one item only) ❑ THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): <br />I. FACILITY INFORMATION <br />FACILITY ID # (Agency Use Only) - - <br />FACILITY NAME s ,a • , 70 '. <br />M03. <br />FACILITY SITE ADDRESS q ,i M04 <br />� CITY �; Op <br />Mos. <br />H. EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE <br />State law requires that testing, preventive maintenance, and calibration of monitoring equipment (e.g., sensors, probes, line leak detectors, etc.) be performed in <br />M06. <br />accordance with the equipment manufacturers'instructions, or annually, whichever is more frequent. Such work most be performed by qualified personnel. <br />MONITORING EQUIPMENT IS SERVICED E 1. ANNUALLY ❑ 99.OTHER (Specify): <br />Mm. <br />III. MONITORING LOCATIONS <br />This monitoring plan most include a Site Plan showing the general tank and piping layouts and the locations where monitoring is performed (i.e., location of each sensor, <br />line leak detector, monitoring system control panel, etc.). If you already have a diagram (e.g., current UST Monitoring Site Plan from a Monitoring System Certification <br />form, Hazardous Materials Business Plan map, etc.) which shows all required information, include it with this plan. <br />IV. TANK MONITORING <br />MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): (Check all that apply) <br />Mle. <br />�• 1. CONTINUOUS ELECTRONIC MONITORING OF TANK ANNULAR (INTERSTITIAL) SPACE(S) OR SECONDARY CONTAINMENT VAULT(S) <br />SECONDARY CONTAINMENT IS: 51 a. DRY ❑ b. LIQUID FILLED ❑ c. UNDER PRESSURE ❑ d. UNDER VACUUM <br />M" <br />PANEL MANUFACTURER: Tm= n StnC.uvv MI2. MODEL #: TK to t3O <br />MD. <br />LEAK SENSOR MANUFACTURER: � Svt I!-Q h M14. MODEL #(S): <br />M15. <br />❑ 2. AUTOMATIC TANK GAUGING (ATG) SYSTEM USED TO MONITOR SINGLE WALL TANK(S) <br />PANEL MANUFACTURER: M16. MODEL #: <br />M17. <br />IN-TANK PROBE MANUFACTURER: Mlg. MODEL #(S): <br />M19. <br />LEAK TEST FREQUENCY: ❑ a. CONTINUOUS ❑ b. DAILY/NIGHTLY ❑ c. WEEKLY <br />M2a. <br />❑ d. MONTHLY ❑ e. OTHER (Specify): Mzl. <br />PROGRAMMED TESTS: ❑ a. 0.1 g.p.h. ❑ b. 0.2 g.p.h. ❑ c. OTHER (Specify): <br />Mzi. <br />❑ 3. INVENTORY RECONCILIATION ❑ a. MANUAL PER 23 CCR §2646 ❑ b. STATISTICAL PER 23 CCR §2646.1 <br />MIO' <br />❑ 4. WEEKLY MANUAL TANK GAUGING (MTG) PER 23 CCR §2645 <br />TESTING PERIOD: Ela. 36 HOURS ❑ b. 60 HOURS <br />MI5. <br />❑ 5. INTEGRITY TESTING PER 23 CCR §2643.1 <br />TEST FREQUENCY: ❑ & ANNUALLY [Ib. BIENNIALLY E]c. OTHER (Specify): MI6' <br />Mzz <br />E 6.VISUAL MONITORING DONE: C, a. DAILY ❑ b. WEEKLY (Regairea agenry app-1) <br />❑ 99. OTHER (Specify)-. <br />M28. <br />V. PIPE MONITORING <br />MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply) <br />❑ 1. CONTINUOUS ELECTRONIC MONITORING OF PIPING SUME(S)/I'RENCH(ES) AND OTHER SECONDARY CONTAINMENT <br />SECONDARY CONTAINMENT IS: ❑ a. DRY ❑ b. LIQUID FILLED ❑ c. UNDER PRESSURE ❑ d. UNDER VACUUM <br />M31. <br />PANEL MANUFACTURER: M32. MODEL #: <br />MI3' <br />LEAK SENSOR MANUFACTURER: M34. MODEL #(S): <br />M35. <br />WILL A PIPING LEAK ALARM TRIGGER AUTOMATIC PUMP (i.e., TURBINE) SHUTDOWN? ❑ & YES ❑ b. NO <br />M36. <br />WILL FAILUREIDISCONNECTION OF THE MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? ❑ a. YES ❑ b. NO <br />M37. <br />❑ 2. MECHANICAL LINE LEAK DETECTOR (MLLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS AND RESTRICTS OR SHUTS OFF <br />PRODUCT FLOW WHEN A LEAK IS DETECTED <br />M38. <br />M39' <br />MLLD MANUFACTURER(s): MODEL #(S): <br />❑ 3. ELECTRONIC LINE LEAK DETECTOR (ELLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS <br />ELLD MANUFACTURER: M40 MODEL #: <br />Mat. <br />a. MIvIUM MONTHLY 0.2 g.p.h. [3b. MINIMUM ANNUAL 0.1 g.p.h. <br />PROGRAMMED LINE INTEGRITY TESTS: [IIN <br />M41 <br />WILL ELLD DETECTION OF A PIPING LEAK TRIGGER AUTOMATIC PUMP SHUTDOWN? ❑ a. YES ❑ b. NO <br />M43. <br />WILL ELLD FAILURE/DISCONNECTION TRIGGER AUTOMATIC PUMP SHUTDOWN? ❑ a. YES [I b. NO <br />MU. <br />❑ 4. INTEGRITY TESTING M45. M46. <br />TEST FREQUENCY: ❑ & ANNUALLY ❑ b. EVERY 3 YEARS E] c. OTHER (Specify) <br />❑ 5.VISUAL MONITORING DONE: ❑ a. DAILY ❑ b. WEEKLY* ❑ c. MIN. MONTHLY & EACH TIME SYSTEM OPERATED-- <br />• Regnirea agency nppn,1W as Allowed for monitoring ofmbuded anageney genaator fuel piping only pa HSC §25281.5(b)(3) <br />M47. <br />�j 6. PIPING IS SUCTION PIPING MEETING ALL REQUIREMENTS FOR EXEMPTION FROM MONITORING PER 23 CCR §2636(a)(3) <br />❑ 7. NO PRODUCT OR REMOTE FILL PIPING IS CONNECTED TO THE UST(s) <br />Mae. <br />❑ 99. OTHER (Specify) <br />SJCEHD-d (07/03) -1/4 u nzo7w <br />