|
09/26/2004 09:06 FAX 1 209 957 4169 PAQ FFORL A/P 2004
<br /> SAN JOAQ COUNTY EN—vIR0NMEN'PAL HEALTH DEPARTMENT
<br /> UNDERGROUND STORAGE TANK
<br /> MONITORING PLAN-PAGE 1
<br /> TYPEOFACTWN tj LNEW PLAN O 2-CHANGE OF INFORMATION M°r•
<br /> PLAN TYPE MONITORING IS IDENTICAL FOR ALL US7h AT THIS FACILITY. aeon.
<br /> (Chocko,citceumly) ❑ THIS PLAN COVERS ONLY TIM POLLUWANG UST SYSTEM(Sr
<br /> ,rye
<br /> n.
<br /> ,.i.r::..'..:.
<br /> . _-e-
<br /> ,"F,i-r nµfn,.c_.. .-J¢r•' �'.. ,";7a.(i !,,1.: z.�-a'b`'----3-i.:Y Yiy4.:i:
<br /> FACILDY ID O(Agnew Use Only)
<br /> In. wp,
<br /> FACRITYNAME MN•
<br /> FAI-111112ADDRBSS O Gt, ra Mai CIS!
<br /> n
<br /> . v+
<br /> {—r.� I_ci�����(�; iL�T'r�"717E1S����- A..1. .:�:,��'Tk]1��1N`T,E� �.''i"3;�=�s�'•:.,1�...4?>rc•1
<br /> Som law require=thn telling,prevemrive moro*cnxkR,and calibrntioa ofntoniroring equipment(e.g.,sensors,probes,line leak oexerors,ere.)be performed in >tOa
<br /> accordance who the equipmcm maoulbcfi 'insnvctions,a annually,mbidlc is marc fMgU=L Such wort MUSE be performed by qualified pasoanel.
<br /> MONITORING EQUIPMENT IS SER4TCED 05 1.ANNUALLY ❑ 99.OTHER(Specify): Mel.
<br /> yrvr:jla7P.ij;ti n?ir"i�n'U::w�:: . :•eti:w:i",_-'r i.iNorr;..rn......... .. .. ... •._.... - - - __ _____ - - -
<br /> C7:P�� •�r...,.r.....a.r�',$�I,:;�,...u.. nrn....l r , w,.. ' � ail r.. _ ',:ai!�1'i3] I;w!i'.:.:i;TB !li
<br /> _ A 4 •Lue4.x,;_..,,, I L .r:g 'Ki^:�;rnl'NC7Li '^'.u.a"•
<br /> c. 'd_- __ - ) �'� .,.fx,:,r�k..,.�4'F.CYl�TP' ��11•+ �Scf .0'E.�TIrQ -LL_ ..ries ut:�lrl:'^.;�on._F,I:._ ^::ar:,,lr_
<br /> •Ibis monilewag plan must Include a Site Flan showing 111e general rank and piping layotas and Ibe Ioeo ions whnemaniteriteg w performed(tc-,location ofacb'mw'
<br /> line Itrak dZtCGIDr,monitoring sysum control panel,etc.). If you a]rmdy have a diagram(e.g. clean UST Monitoring Site Plan Ram a Monitoring Sysresn Ctrti5orim
<br /> form.As>zdous Materials HUsjDaas Plan MAP,brc.l which shows all aired vrfotmnion,include icwith dus ran.
<br /> y=•yi ' �.r -- ��c:iAe -y� ('� (l L'�•.Ms'.�.v, :`'i:i•'�I'_�w__ _ p:}a
<br /> i 1trY
<br /> wl.
<br /> MOWTORING IS PFRFORMYA USING'=FOLLOWING METHOD(S);(Check all that apply) rano.
<br /> ❑ I.CONTINUOUS ELECTRONIC MONITORING OF TANK ANNULAR(INTERSTITIAL)SPACE(M OR SECONDARY CONTAINMENT YAULT(S)
<br /> ,ySECONDARY CONTAINMENT IS:/ 'E01 a.DRY ❑ b.LIQUID FD1.P.D [3 c.UNDER PRESSURE ❑ d.UNDER VACUUMM (-
<br /> PANELMANUFAC7UREIC M1z MODEL#: ET4S —3S`O Mr.
<br /> LEAK SENSOR MANUFACTURER euDa%_ 2.r- Mi` MODEL#(S):74c/3
<br /> ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANKIS)
<br /> PANEL MANUFACTURER: Mir` MODFLIJ: M17-
<br /> IN-TANK PROBE MANUFACTUR.OU MM MODEL#(S), Mr9.
<br /> LEAK TEST FREQUENCY. ❑ a.CONTINUOUS ❑ b.DA.ILY/NIOHTLY ❑ c_WEEKLY Mid'
<br /> ❑ d.MONTHLY ❑ e.OTHER(Speell�,): rat.
<br /> PROGRAMMED TESTS: 0 a.0.1 g.p.h. ❑ b.02 gp.h. ❑ c 071•lER(Specify): ^'�' �.
<br /> Q 3.1NYFN70RY RECONCILIATION ❑ a.MANUAL PER 23 CCR§26,16 ❑ b.STATISTICAL PER 23 CCR§2646.1 Mee.
<br /> ❑ 4.WEEKLY MANUAL TANK GAUGING 091TG)PEP.23 OCR§2645
<br /> TESTING PERIOD: ❑ 2.36 HOURS ❑ b.60 HOURS oras.
<br /> ❑
<br /> S.INTEGRITY TESTING PER 23 CCR§2543.1
<br /> TEST FREQUENCY: Q a.ANNUALLY ❑ b.BIENNIALLY ❑ c OTHER(Specify); ho=d'• sac'r.
<br /> ❑ 6-VISUALMONITORNGDONE: ❑ a_DVLY Q b.WEEKLY rceari.G Ngalq,ggowD
<br /> ❑
<br /> 99.OTHER(Spccsfy): I.Oa
<br /> w: „
<br /> li•iSrll' -..'�.0 ..h�:�.Mti 1 � _ ::� :..(.- :7��iirML :�.nn,�'ni!.:i�,��y}Jy..•
<br /> ..v..a.v •L"-ly . + :='J2�:.�.rr✓;��h�:..:✓"'.r-.:-g._s:...::o—.: �' -r�l�- C' :S.i4'' F1;i7:s- - �AF}1. '.1
<br /> w
<br /> ��'1'.11Yal:.VlY{Lr).�3''-�.:".' ''i^�',�•1,'�_Cigl I.lrn:'iJ.1i n.4"r
<br /> MONITORING IS PERFORMED USING THE FOLLOWING METHOD($)(CTc]t allfiai apply) --- wa'
<br /> ❑ I.CONTIvUOUSELECTRONICMONITORINGOFPMTt4OSLIMP(SNIRENCFI(FS)ANDOTHRRSECONDARYCOMAZfXENT
<br /> SECONDARY CONTAI MEET IS: M &D ❑ D-LIQUID FILLED ❑ c.UNDER PRESSURE 11 &UNDER VACUUM DBI.
<br /> PANELMANUFACYURER: VeAFb&L — Qaxa>' ''L"= MODEL#- If —ASO Mr.
<br /> LEAK SENSOR MANUFACTURER: e _ we. MODEL 9(S} Nx
<br /> WILLA PIPING LEAK ALARM TRIGGER AUTOMATIC?LIMP(i-.,TURBINE)SHUTDOWN7 o.YE5 ❑ b.NO Mia
<br /> wA_L.FAILUREMISCONNEC170N OFTMEMONITORINGSYSTEM TR10GERAUTOMATICPIW SHUTDOWN? ® &M L] b.NO •
<br /> Ip 2.MECHANICAL LINE LEAK DETECTOR (MLLD) THAT ROUTINELY PERPORMS 3.0 gp-h- LEAK TESTS AND RESTRICTS OR SHUTS OFF
<br /> PRODUCT FLOW WIZEN A LEAK,
<br /> EAK LSIIID
<br /> MLLD MANUFACTURER(sy -R D T�G k�� MSA .MODEL Y(5): �X 9_ y boo.
<br /> ❑ 3.ELECTRONIC LINE LEAK DETECTOR.QBLLO)THAT ROUTI+R.t v PERFORMS 3-0&p.11.LEAK TESTS
<br /> ELLO MANUFACTURER -. .. _ M"° MODEL)I; Ms+.
<br /> PROGRAW47ED LINE INTEGRITY TESTS: ❑ a.MINIMUM MONTHLY 0.2 g.p.h. ❑ b_MINI4UMANNUAL0,1gph Ma'
<br /> WILL ELLD DETBCAON OF A PIPING LCAKTRIGGERAUTOMATIC PUMP SHUTDOWN, a.YES ❑ h NO
<br /> WIMELLA FAILUREIDISCONNECTION TRIGGER AUTOMATIC PUMP SHUTDOWN? `� yYES ❑ hN0 ].Yl
<br /> ❑ a.INTEGRITY TESTING
<br /> TESTFREQUENCY: Q e.ANNUAILY ❑ b.EVERY YEARS OTHUR(Specffy) � � aw. Mea.
<br /> ❑ 5.VI9LALM0NITORING DONE: ® a.DAI..Y ❑ b.WEEKLY'
<br /> [j c.AfIN.MDNf1bY 54 EACB'DMB Sxgt�i q OpPpgATpp� yyy�.
<br /> •RNTS Y9+Icy appeal ••Mcrae nnmmii IT efwhuej� R?3C CCR
<br /> llb'pv REt 5f}9s1.5tbjQ)
<br /> ❑ 6.PIPING L5 5 UCnON PrPMG MEETING_4LL REQUIREMENT$FOR EXEMPTION FROM MONITORING PER?3 CCR 32636(x)(3)
<br /> ❑ 7.NO PRODUCT OR REMOTE FILL PIPING IS CONNECTED TO THE UST(s) -
<br /> ❑
<br /> 99-OTHER($ImD*) we
<br /> S3CEI*"(07/03)-L4 07Pf3/03
<br /> ZO 3UCd a017Tl:4 H141I-i ECbE891760Z 9Z:5T t100Z/LZ/60
<br />
|