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� • a UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN- Pae I of 2) TYPE OF ACTION ❑ I.NEW PLAN 2'2.CHANGE OF INFORMATION 4x1 PLAN TYPE 1.MONITORING IS IDENTICAL FOR ALL USTS AT THIS FACILITY. 490-2 (Check one item only) ❑ 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S) FACILITY ID#(Agency Use Only) I. FACILITY INFORMATION_ 1 BUSINESS NAME(Same as FACILITY NAME) 3 N r BUSINESS SITE ADDRESS p 103. o 7 u /f CITY H.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 frequen4 and that such work must be performed by qualified personnel. 23 CCR 2632,2634,2638,2641 MONITORING EQUIPMENT IS SERVICED l�.ANNUALLY ❑ 99.OTHER(Specify): 610.3a 490-3b M.MONITORING LOCATIONS L NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 2634 0 IV.TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT 490-5 VAULT(S)WITH AUDIBLE AND VISUAL ALARMS. (23 CCR§2632,2634) SECONDARY CONTAINMENT IS: ❑ a.DRY 23.LIQUID FILLED ❑ c.PRESSURIZED ❑J.UNDER VACUUM 490-3 PANEL MANUFACTURER: I/'g 490-1. MODEL#: a x90--3 LEAK SENSOR MANUFACTURER: Vcp 090.9' MODEL#(S): 49 10 2.AUTOMATIC TANK GAUGING(ATC)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).(23 CCR§2643) 490-11 PANEL MANUFACTURER: 490.12. MODEL#: 49x13 IN-TANK PROBE MANUFACTURER: 490"14 MODEL#(S): 490-15 LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILYINIGHTLY ❑ c.WEEKLY 490-16 ❑ d.MONTHLY ❑ e.OTHER(Specify): +90.13 PROGRAMMED TESTS: ❑ a.0.1 g.p.h. ❑ b.0.2 g.p.h. ❑ c.OT14ER(Specify): 49018 490-19 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 490-x0 ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§2645). TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS 49x21 ❑ 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 490.22 4%.23 TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): 490-24 490.25 ❑99.OTHER (Specify): 4w-26 490-z3 V.PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) I.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 490-28 VISUAL ALARMS. (23 CCR§2636) SECONDARY CONTAINMENT IS:LK DRY ❑b.LIQUID FILLED ❑c.PRESSURIZED ❑d.UNDER VACUUM 490-29 PANEL MANUFACTURER: a,s. / 12,.t DEL#: L ,0 :jf 31 LEAK SENSOR MANUFACTURER: lI °90.)2 MODEL#(S): s" a arn-33 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. B1 YES ❑It.NO 490'34 FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. [!';YES ❑b.NO 490-35 IsT Z.MECHANICAL LINE LEAK DETECTOR(ML D)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS AND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK IS DETE E 23 CCR 2636 49 36 MLLD MANUFACTURER(S): 490-33 MODEL#(S): to 5t &&- 25106 490.36 ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS (23 CCR§2636) 490-39 ELLD MANUFACTURER(S) 490'°0 MODEL#(S): 491141 PROGRAMMED IN LINE LEAK TEST: ❑ 1.MINIMUM MONTHLY 0.2 g.p-h. ❑ 2.MINIMUM ANNUAL 0.1 g.p.h. 49042 ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 090.43 ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a YES ❑b.NO 4% 4.PIPE INTEGRITY TESTING 490-45 TEST FRE UENCY a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHERS i 490<649043 .VISUAL if MONITORING. FRE UENCY 49048 Q 8"a.DAILY ❑ b.WEEKLY ❑c.MIN.MONTHLY&EA TIME SYS EM OPE[WTED -390.x9 •Allowd for mwNorin of wbutl dem m rnemlor fud i 'n oNv HSC 25281. b 3 /4Q l „� ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR§2636(a)(3)1. 49 50 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CRAFTER 6.7 IS CONNECTED TO THE TANK SYSTEM 9o-s1 ❑ 99.OTHER(Specify) 49052 491453 UPCF UST-D(12/2007)1/4 l