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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN-(Page 1 of 2) TYPE OF ACTION ❑ L NEW PLAN ® 2.CHANGE OF INFORMATION 496I' PLAN TYPE ® 1.MONITORING IS IDENTICAL FOR ALL USTS AT THIS FACILITY. 490.' (Check one item only) ❑ 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) BUSINESS NAME(Same as Facility Name or DBA) 7-Eleven # 14117 3 BUSINESS SITE ADDRESS 2725 Country Club Dr 103. 1 CfTY Stockton IN. II. EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE Testing,prev®tivc maintenance,and calibmtion of moaitoring equipment(c.g.,sensors,per•line leak detectors,etc.)must be performed at the frequency specified by the equipatent manufacturers'instructions,or annually,whichever is more frequent.Such work must be perfanned by qw1ified personnel.In oza 1+-63z 2634.2638.23411 MONITORING EQUIPMENT IS SERVICED ® 1.ANNUALLY 1199.OTHER(Specify): 4 o-3b. M. MONITORING LOCATIONS ❑ 1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN ® 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED InCLR 1263226341 4904. IV. TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) = 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) 4965. WITH AUDIBLE AND VISUAL ALARMS.In ccR§2632.2634( SECONDARY CONTAINMENT IS: ® a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED ❑ d.UNDER VACUUM 490'6' PANEL MANUFACTURER: Veeder-Root 4962. MODEL#: TLS-350 LEAK SENSOR MANUFACTURER: Veeder-Root 490.9' MODEL#(ST 794390-420 49610. -CF2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).In cca 12b43I aso11. PANEL MANUFACTURER: 490.12. MODEL#: 4W13. IN-TANK PROBE MANUFACTURER: 49614. MODEL#(S): 490.15. LEAK TEST FREQUENCY: ❑ a.CONTIN000S ❑ b.DAILYINIGHTLY ❑ c.WEEKLY 49016 ❑ d.MONTHLY ❑ e.OTHER(Specify): 49m.17. PROGRAMMED TESTS: ❑ a.0.1 It. ❑ b.0.2 h. ❑ c.OTHE (Specify): 49 19.lr. g.p• B•P ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION In cca 12616.11 49620. ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)incot i2 i TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS496+21. 496+� ® 5.TANK INTEGRITY TESTING PER In cat 1:343.11 496n. TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ® c.OTHER(Specify) SB989 evaT 36 months 494 W U ® 99.OTHER(Specify): Overfill-Flapp43r 497 V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) ;