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r' • UNIFIED PROGRAM CONSOLIDATED FOrM UNDERGROUND STORAGE TANK MONITORING PLAN- (Page 1 of 2) TYPE OF ACTION ❑ 1.NEW PLAN R 2.C14ANGE OF INFORMATION 41 PLAN TYPE1.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. 490-z (Check one item only) ❑ 2.=PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) 3 BUSINESS NAty¢(Same as Facility Name or DBA) 3 JCS Z BUSINESS SITE ADDRESS 103 CI'C . 0 n.v' Q UI /';J� IL 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 epTpnm nt manufacturers'instructions,or annually,whichever is more frequent Such work must be,Perfonned by 2ualifie�rsonnel._.[23 CCR§263z 2634,z_63a 2"1] MONITORING EQUIPMENT IS SERVICED 1.ANNUALLY ❑ 99.OTHER(Specify): 490-3a 490-3b. III. MONITORING LOCATIONS ❑ 1.NEW SITE PLOT PLANIMAP SUBMITTED WITH THIS PLAN w .SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED [23 CCR§2632,2634 4914 ;A;-TANK-MAAIITOR-FNG-IS-ILERFO&MEB-14 NG-THE-FOLLOWING- - ckeek all that apply) 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULTS) 490.5. WITH AUDIBLE AND VISUAL ALARMS.[z3 ccR§z63z,x634 SECONDARY CONTAINMENT IS: ❑ a.DRY Mb.LIQUID FILLED ❑ c.PRESSURIZED ❑ d.UNDER VACUUM 490'b PANEL MANUFACTURER: V615W1-4/L- 11 " 01 490-3 MODEL#: 'T§- S '- 3 jamb 490.8_ LEAK SENSOR MANUFACTURER: i AQ'S,%1%.1L, 490-9. MODEL#(S): 3 ea'Z., 490-10. ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).In CCR§2643) e9ai il, PANEL MANUFACTURER: 490-12_ MODEL#: 490.13. IN-TANK PROBE MANUFACTURER: 490x4' MODEL#(S): 490.15. LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY 490-16_ ❑ d.MONTHLY ❑ e.OTHER(Specify): 490-17 PROGRAMMED TESTS: ❑ a.0.1 g.p.h. ❑ b.0.2 g.p.h. ❑ c.OTHER(S city): 4-19 90-15. 49D .-E-1-3--MONTHLY STATISTICAL INVENTORY RECONCILIATION In ccR§26e6.1) _❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)123 CM§2451 TESTING PERIOD: ❑ a 36 HOURS _❑ b.60_HOURS 4�u 21' E] 5.TANK INTEGRITY TESTING PER[23 CCR§243.114W23, 4W23, TEST FREQUENCY: [I &ANNUALLY_ ❑ b.BIENNIALLY D c_.OTHER(Spec_ 490-24. 490-25. JZ 99.OTHER Ml N Tb fL I fJ 6 ? If "rj M V 6'L r 'ANL 490 io-2. 7. V. PIPE MONITORING IS PERF RMED USING THE FOLLOWING METHOD(S) (Cheecke" that1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE&VISUAL ALARMS. 4902. [§2 CCRSECONDARY CONTAINMENT IS: a.DRY ❑ b.LIQUID FILLED §26366] ❑ c.PRESSURIZED ❑ d.UNDER VACUUM 490-29 PANEL MANUFACTURER: V A„e"X'y A&O'r 49x30. MODEL#: ^rL.-S- a i!'b 490-31. LEAK SENSOR MANUFACTURER: J(1j4J>6'L.- /L.o e^r 490.32. MODEL#(S): 2-Q 490-33, PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. ❑ a.YES JK b.NO 490.34. FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES Wb.NO 490.35. ❑ 2.MECHANICAL LINE LEAK DETECTOR MLLD THAT ROUTINELY PERFORMS 3.0 --- ( ) g.p.h.LEAK TESTS AND RESTRICTS OR SHUTS OFF 490.36. PRODUCT FLOW WHEN A LEAK IS DETECTED.[z3 ccR§26361 MLLD MANUFACTURER(S): 49 37, MODEL 4(S): 49 39. ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS.[29 CCR§26361 4911-39. ELLD MANUFACTURER(S): 49 .. MODEL#(S): 49x-11. ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ❑ b.NO 49 1. ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ❑ b.NO 490-a4. ❑ 4.PIPE INTEGRITY TESTING. ----- 49045. TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER( a �)S ci 490.46. iK.5.VISUAL PIPE MONITORING. -A9-04T 9 saes PPPP FREQUENCY: ❑ a.DAILY ❑ b.WEEKLY .�6ryI c.MM.MONTHLY&EACH TIME SYSTEM OPERATED. 490 9. - ON Allowed for maRibrin og fwbuned emeecalg gmeruorfuel vSin�anly Qer_Fi$C�252B1.5(bX3-L ❑ 6.SUCTIPIPING MEETS EXEMPTION CRITERIA.123 test§2636[,7(3)1 490-50. ( ❑ 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.715 CONNECTED TO THE TANK SYSTEM. 49051. 99.OTHER(Specify) ( ^%, i- yFyL_(�-n/ ,C�1,(L --' ---- 4�4W52. - UPCF UST-D(12/200'7)-1/4 www.unidocs.org