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Ar- bl ED PROGRAM CONSOLIDATED FORM Si'•w UNDERGROUND STORAGE TANK MONITORING PLAN- Pae I of 2) TYPE OF ACTION ® L NEW PLAN [12.CHANGE OF INFORMATION - 49x1 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) I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) BUSINESS NAME(Same as FACILITY NAME) 3, George's Mini Mart _ BUSINESS SITE ADDRESS 101 CITY 101 18662 N HWY 88 Lockeford,CA 95237 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 frequent,and that such work must be performed by qualified personnel. (23 CCEj2632,26L4,2638, -------`---_.--------------------------_- ----------- ------------------------------------------------------------ MONITORING EQUIPMENT IS SERVICED ® I.ANNUALLY El 99.OTHER(Specify): 4W3b III.MONITORING LOCATIONS ❑ 1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 2634)4904 IV,TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): I.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 ❑ b.LIQUID FILLED ❑ c.PRESSURIZED ❑d.UNDER VACUUM 490'6 _-_._._ .___.,-___-__---_________.______ .__--.__ _r PANEL MANUFACTURER: Gilbareo 490- MODEL# EMC °gas '-'-'-----------------`--'--------- LEAK SENSOR MANUFACTURER: VEEDER ROOT 490-9 MODEL# S : 420 °solo 2.AUTOMATIC TANK GAUGING(ATC)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).(23 CCR§2643) 49x11 PANEL MANUFACTURER: -----M-12 -_MODEL#:---- -'----------------- 49x13 IN-TANK PROBE MANUFACTURER: 490-14 MODEL#(S): 49x15 LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ I.DAILYNIGHTLY ❑ c.WEEKLY 49x16 d.MONTHLY � e.OTHER(Specify):________________-___._.___-___-. 490-17490.16 PROGRAMMED TESTS: ❑ a.0.1 g.p.h. ❑ b.0.2 g.p.h. ❑ c.OTHER(Specify): 490-19 ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 49x20 F] 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§2645). TESTING PERIOD: E] a.36 HOURS ❑ b.60 HOURS 4 22 El 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 49°23 TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHEReci 490-24 (S p �') 490-25 El99.OTHER (Specify): 49x26 49az2 V.PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply) 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 49x213 VISUAL ALARMS. (23 CCR§2636) SECONDARY CONTAINMENT IS: At.DRY ❑b.LIQUID FILLED []c.PRESSURIZED ❑d. UNDER VACUUM 490-29 _ _______-_490-00 49x31 LEAK SENSOR MAN0 1_ }_.__________.:.__.._ PANEL MANUFACTURER: MODEL# 5W1L__-_----------- _-_--_-__-__-- UFACTURER: °9°-32 I MODEL#(S)__�S_ _ 490.3) PIPING LEAK ALARM TRRIN IGGERS AUTOMATIC PUMP i.e.,TUBE)SHUTDOWN. ®a.YES ❑b.NO 490.34 FAILUREIDISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. I§a.YES ❑b.NO 490-35 2.MECHANICAL LINE LEAK DETECTOR(MLLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS AND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK_IS DETECTED(23 CCR 1§2T636) 49x36 MLLD MANUFACTURER(S):VMI,RED JACKET �i�4.iV 490-77 MODEL#(S): 99LD2000 )w{� 490-3s ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS (23 CCR§2636) 490.39 _ ______________.__.-_-______._.__.------------- ELLD __a��_ _-_-_ _-_.______.490-40 i MODEL#(S): 07051023 ____ELLD MANUFACTURER(S) _ _ ______ __ _ _ PROGRAMMED IN LINE LEAK TEST: ❑ I,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 49x°3 ELLD FAILUREIDISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ❑b.NO 490"g4 ❑ 4.PIPE INTEGRITY TESTING 49045 TEST FREQUENCY ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS. ❑ c.OTHER(Specify) 490-1649042 ❑ 5.VISUAL PIPE MONITORING. 4�8 FREQUENCY ❑ a.DAILY ❑ b.WEEKLY ❑C.MIN.MONTHLY&EACH TIME SYSTEM OPERATED- 490-49 'Allowed for monitoring ofunburied emnerIey gcneraor fuel piping only HSC 252131.5 l ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR§2636(a)(3)1. 49050 ❑ 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM 49x51 490-52 ❑ 99.OTHER(Specify) 490-53