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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUNDSTORAGETANK MONITORING PLAN- Pae 1 of 2 TYPE OF ACTION I.NEW PLAN ❑ 2.CHANGE OF INFORMATION 490-1 PLAN TYPE I.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. 490-2 `1 (Check one item only) ❑ 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S) L FACILITY INFORMATION FACILITY ID#(Agency Use Only) BUSINESS NAME(Same as FACILITY NAME) , BUSINESS SITE ADDRESS C V tia-tl'4K r, 103. CITY -T� II.EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE Testing,preventive maintenance,and calibration of monitoring equipment(e.g.,sensors,probes,line leak detectors,etc.)must be performed at the frequency specified by the equipment manufacturers'instructions,or annually,whichever is more frequent,and that such work must be performed by qualified personnel. 23 CCR§2632,2634,26382641 _ MONITORING EQUIPMENT IS SERVICED 1A I.ANNUALLY ❑ 99.OTHER(Specify) 490-3i 49°-36 III.MONITO NG LOCATIONS ❑1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN.A 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 2634)4%4 IV.TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): 11 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT 4905 VAULT(S)WITH AUDIBLE AND VISUAL ALARMS. (23 CCR§2632,2634) SECONDARY CONTAINMENT IS: ❑ a.DRY 14 b_LIQUID FILLED ❑ c_PRESSURIZED ❑d.UNDER VAC 49 PANEL MANUFACTURER: 490-1. MODEL#: LEAK SENSOR MANUFACTURER: 490'9. MODEL#(S): 49°'10 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TOMONITOR SINGLE WALL TANK/S).(23 CCR§2643) 49o-u PANEL MANUFACTURER: 490-12. MODEL#: 490-13 490-14. 49a-i5 IN-TANK PROBE MANUFACTURER: MODEL#(S): LEAK TEST FREQUENCY: . ._____a%__6 Q ❑ a.CONTINUOUS ❑ b.DAILYMIGHTLY ❑ c.WEEKLY d.MONTHLY49°.17-__. �e.OTHER�Spec�:_ PROGRAMMED TESTS: ❑ a.0.1 g.p.h. ❑ b.0.2 g.p.h. ❑ c.OTHER49-318 (S 13ecJy): 490-19 ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 090'20 ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§2645). TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS 490-11 49032 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 490.23 TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): 490-24 490-25 ❑99.OTHER (Specify): 49x26 49-3-27 V.PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 490-28 VISUAL ALARMS. (23 CCR§2636) SECONDARY CONTAINMENT IS:®a.DRY ❑b.LIQUID FILLED [1c.PRESSURIZED ❑d.UNDER VACUUM 4"29 PANEL MANUFACTURER: 490-30 MODEL#: 1 LEAK SENSOR MANUFACTURER: . 490-32 MODEL#(S): 49 33 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. 3ala.YES ❑b.NO 490-34 FAILUREIDISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ND.YES ❑b.NO 490-35 2.MECHANICAL LINE LEAK DETECTOR(MLLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TES AND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK IS DETECTED 23 CCR 26 49036 MLLD MANUFACTURER(S): 1/m 490'31 MOD #(5 EL :q _-_-_ 49-338 ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS (23 CCR§2636) 490-39 _ELLD MANUFACTURER(S) _ _ __ 49 1. 1 MODEL#(S): _ 49041 PROGRAMMED IN LINE LEAK TEST: ❑ 1.MINIMUM MONTHLY 0.2 g.p.h. ❑ 2.MINIMUM ANNUAL 0.1 g.p.h. 490°2 ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 49043 ELLD FAILUREIDISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 49044 Lj 4.PIPE INTEGRITY TESTING 49045 TEST F UENCY a.ANNUALLY b.EVERY 3 YEARS c.OTHERS i 49046490.47 5.VISUAL PIPE MONITORING. 490-48 FREQUENCY ❑ a.DAILY ❑ b.WEEKLY ❑C.MIN.MONTHLY&EACH TIME SYSTEM OPERATED- 49049 •Ail w form -ng ofunburied ane en eneridor fuel piping mly W HSC 252815 3 ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR§2636(a)(3)1. 490-50 T NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM 490-51 ❑ 99.OTHER(Specify) d�S3 UPCF UST-D(12/2007)1/4