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IFIED PROGRAM CONSOLIDATED FORM UNDERGROUNDSTORAGETANK MONITORING PLAN - Pae 1 Of 2) ago TYPE OF ACTION ❑ I.NEW PLAN 2.CHANGE OF INFORMATION a9o-z. PLAN TYPE I.MONITORING IS IDENTICAL FOR ALL US is AT THIS FACILITY. (Check one item only) 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) - - 3. BUSINESS NA E(Same as Facility Name or DBA)I�k S 1-k XPpnE55 103. CITY a. BUSINESS SITE ADDRESSir.�„� t, .5?, AA'.2wr ti/ J/a 5-.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 firequency specified b the ui rent manufacturers mstruc[ions or amuall ,whrchever is more fire,.vent.Such work must be performed! ,qualified personnel[23 CCR§2632_.2634,2638 ,.641)_ _....y _ �[ P......_ ...... ^A_............ ............... .... 490-3a. _.-. ..-.-..... -....y . .. MONITORING EQUIPMENT IS SERVICED �, L ANNUALLY ❑ 99.OTHER(Specify): 490-3b. III. MONITORING LOCATIONS 490A. ❑ 1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN 2.SITE PIAT PLAN/MAP PREVIOUSLY SUBMITTED l23 CCR§2632,x6341 [V. TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD($ (Check all : that a 19 L CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) 490-5. WITH AUDIBLE AND VISUAL ALARMS.[23 CCR§2632,2634) TG L# MODE : S 350 490490-6 0. SECONDARY CONTAINMENT IS: 11a.DRY b.LIQUID FILLED 11 c. c.PRESSURIZED [Id.UNDER VACUUM . PANEL MANUFACTURER: �J(fan s� P'raT - 49a10 _LEAK SENSOR MANUFACTURER: - 7� .. VIIE0�' �0T 4909 ,MODEL#(S)_.�l(C, 301 .-.--.__ ... ....- ......- -.. ago-11. ❑ 2 AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TA NKiS) [23 cca§x6431 49413. PANEL MANUFACTURER: n�IA MODEL#. IN-TANK PROBE MANUFACTURER: 490-14. MODEL#(S): 49o-1s. LEAK TEST FREQUENCY: a.CONTUOUS [Ib.DAILY/NIGHTLY ❑ c.WEEKLY 490-1e. ElIN 490-1r. ❑ d.MONTHLY ❑ e.OTHER(Specify): 490.18. PROGRAMMED TESTS ❑ a O.I.g.p.h ❑ 6 o.2 g.p.h. ❑,c_OTHER(Specify): ago-15-...-._ - 1- 1 ................. ......... .. .. 49420. ,❑ 3 MONTHLY STATISTICAL INVENTORY RECONCILIATION[ 3 CCR 52646.11 _ WEEKLY MANUAL ..._...._ _...._... .. .._.___..... _.............. . ..___. ---- 1...... .. ..... _._ _.... 49090.'1. ❑ 4 WEEKLY MANUAL TANK GAUGING(MTG)[_3 CCR§2645-1 _ TESTING PERIOD ❑ a 36 HOURS ❑ b.60 HOURS _. ....._:_.. .__ ....__._ ..__.. ...... 5.TANK INTEGRITY TESTING PER(23 CCR§2643.q _ TEST FREQUENCY: ❑ a ANNUALLY ❑ b BIENNIALLY ❑ c.OTHER(Specify): B�i�/4- ��Ll�6b 4904-20-x4. ........._._.. . ..__ ._-_.. -._ ❑ 99.OTHER(Specify): 090-27 (Chck V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) that a that ap ly) I.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE&VISUAL ALARMS. 490-28. C'§326'3'61' 490.29. SECONDARY CONTAINMENT IS: � a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED ❑ d.UNDER VACUUM PANEL MANUFACTURER: 490-'0 MODEL#: "TLS -.3�jJ 490-31. LEAK SENSOR MANUFACTURER: 1GarGp"IL T- 49°11 MODEL#(S): )9e/3$J .eil�r33. PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. 'a a.YES ❑ b.NO 4W-34. FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. R a.YES ❑ b.NO 490-31. �, 2.MECHANICAL LINE LEAK DETECTOR(MELD)THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS AND RESTRICTS OR SHUTS OFF 49436. PRODUCT FLOW WHEN A LEAK IS DETECTED.123 CCR§26361 MELD MANUFACTURER(S): 'Ce Ag-ow 490-3T MODEL#($): ST4 IKCGD 490-38. ❑ 3 ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS [ 3 CCR§26361 490-39, ELLD MANUFACTURER(S): 49040. MODEL#(S): 49041. PROGRAMMED IN LINE LEAK TEST: ❑ a.MINIMUM MONTHLY 0.2 g.p.h. ❑ b.MINIMUM ANNUAL 0.1h. 480-4'- 8P ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ❑ b.NO 4W43. ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ .... ._.___.. .., a.YES b.NO .. ......... . .. . ......... . 490'4°' 49045.4.PIPE INTEGRITY TESTING. 9046. TEST FREQUENCY a ANNUALLY ❑ b EVERY 3 YEARS ❑ c OTHER(Specify) 490-42 .._.._...._-_ ._.._.._.._ ............. .__--.._.._ ........... ----.__,._ ._... .._.__... _- _. 5.VISUAL PIPE MONITORING. 49048. FREQUENCY: f�a.DAILY ❑ b WEEKLY ❑ C.MIN.MONTHLY&EACH TIME SYSTEM OPERATED 49 9. ._ _..._... ............-_ _.___._._._..... .. ....... d,Po momm nl,ofunEaried ern S--ry&mere. r(vel PSE konlyper H6[§2528 LSIb1U1__ ___ ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA [23 CCR§2636(aH3)j490-so. ❑ 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM a9a-s1. _. .............. ........_.._._._.__. ....... _ . .._-_.- ........_.. ..__._. .....-.-.. _. .......... .. .490=32:- ❑ 99.OTHER(Specify) 490-53. UPCF UST-D(1212007)-1/4 www.unidocs.org