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UNDERGROU,...3 STORAGE TANK MON-_.,'ORING PLAN For use by Unidocs Member Agencies or where approved by your Local Jurisdiction Authority Cited: Title 23 CCR, Sections 2632(d)(1), 2634(d)(2), and 2641(h) M01 TYPE OF ACTION L NEW PLAN ❑ 2.CHANGE OF INFORMATION Mo" PLAN TYPE ® MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. (Check one item only) ❑ THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) - Mo3 FACILITY NAME Costco Wholesale Corporation gas station#653 FACILITY SITE ADDRESS 3254 West Grantline Road M04 CITY Tracy, 95377 M05. II. EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE State law requires that testing,preventive maintenance,and calibration of monitoring equipment(e.g.,sensors,probes,line leak detectors,etc.)be performed in M06. accordance with the equipment manufacturers'instructions,or annually,whichever is more frequent. Such work must be performed by qualified personnel. M07 MONITORING EQUIPMENT IS SERVICED E L ANNUALLY ❑ 99.OTHER(Specify): III. MONITORING LOCATIONS This monitoring plan must include a Site Plan showing the general tank and piping layouts and the locations where monitoring is performed(i.e.,location of each sensor, line leak detector,monitoring system control panel,etc.). If you already have a diagram(e.g.,current UST Monitoring Site Plan from a Monitoring System Certification form,Hazardous Materials Business Plan map,etc.)which shows all required information,include it with this plan. IV. TANK MONITORING MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S):(Check all that apply) Mao ® 1.CONTINUOUS ELECTRONIC MONITORING OF TANK ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) SECONDARY CONTAINMENT IS: ❑ a.DRY ® b.LIQUID FILLED ❑ c.UNDER PRESSURE ❑ d.UNDER VACUUM MI I PANEL MANUFACTURER: Veeder Root _ Mlz MODELM 35OR MIs. LEAK SENSOR MANUFACTURER: Veeder RQot _ M14. MODEL#(s): 794380-301 MIS ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANKS) PANEL MANUFACTURER: MI6. MODEL#: MI7. IN-TANK PROBE MANUFACTURER: MIs. MODEL#(S): MM LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY M26. ❑ d.MONTHLY ❑ e.OTHER(Specify): M21 PROGRAMMED TESTS: ❑ a.0.1 h. ❑ b.0.2 h. ❑ c.OTHERM22. M23 g.p.h. g.p. (Specify): ❑ 3.INVENTORY RECONCILIATION ❑ a.MANUAL PER 23 CCR§2646 ❑ b.STATISTICAL PER 23 CCR§2646.1 M24 ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)PER 23 CCR§2645 TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS M25 ❑ 5.INTEGRITY TESTING PER 23 CCR§2643.1 TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): M26. M27 I� 6.VISUAL MONITORING DONE: 19 a.DAILY ❑ b.WEEKLY(Requires agency approval) ❑ 99.OTHER(Specify): M28 V. PIPE MONITORING MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) M30 ® 1.CONTINUOUS ELECTRONIC MONITORING OF PIPING SUMP(S)/TRENCH(ES)AND OTHER SECONDARY CONTAINMENT SECONDARY CONTAINMENT IS: ® a.DRY ❑ b.LIQUID FILLED ❑ c.UNDER PRESSURE ❑ d.UNDER VACUUM M31. PANEL MANUFACTURER:Veeder Rclot M32. MODEL#: 350R M73, LEAK SENSOR MANUFACTURER: Veeder Root MU MODEL#(S): 794380-352 M35 WILL A PIPING LEAK ALARM TRIGGER AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN? ® a.YES ❑ b.NO M36. WILL FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? N a.YES ❑ b.NO M37 0 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 MLLD MANUFACTURER(s):Red Jacket, Vaporless M38. MODEL#(S): FX2V. t-Q2000 _ M39. ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS ELLD MANUFACTURER: M40 MODEL#: M41 PROGRAMMED LINE INTEGRITY TESTS. ❑ a.MINIMUM MONTHLY 0.2 g.p.h. ❑ b.MINIMUM ANNUAL 0.1 g.p.h. M42. WILL ELLD DETECTION OF A PIPING LEAK TRIGGER AUTOMATIC PUMP SHUTDOWN? ❑ a.YES ❑ b,NO M43 WILL ELLD FAILURE/DISCONNECTION TRIGGER AUTOMATIC PUMP SHUTDOWN? ❑ a.YES ❑ b.NO M44 ❑ 4.INTEGRITY TESTING TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(Specify) M45 M46 0 5.VLSUAL MONITORING DONE: 0 a.DAILY ❑ b.WEEKLY" ❑ c.MIN.MONTHLY&EACH TIME SYSTEM OPERATED.- M47 • Requires agency approval '•Allowed For monitoring of unburied emergency generator fuel piping only per HSC§25281,5(b)(3) El6.PIPING IS SUCTION PIPING MEETING ALL REQUIREMENTS FOR EXEMPTION FROM MONITORING PER 23 CCR§2636(a)(3) ® 7.NO PRODUCT OR REMOTE FILL PIPING IS CONNECTED TO THE UST(s) ❑ 99.OTHER(Specify) Mos UN-022A-1/5 www.uiaidocs.org Rev.10/14103