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ECEf10050 4.0 UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN- age 1 of 2) TYPE OF ACTION ❑I.NEW PLAN Q 2.CHANGE OF INFORMATION Ova PLAN TYPE ❑ 1.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. 490'2 (Check one item only) ® 2.TIES PIAN COVERS ONLY THE FOLLOWING UST SYSTEM •Tank#4-LUBRIZOL I. FACH rrY INFORMATION FACUM ID#(Agency Use Only) - - 1 BUSINESS NAME(Same s0-FACILITY NAME) Costco Gasoline(Loc.No.658) 3. BUSINESS SITE ADDRESS 3250 West Grant Line Road Im. CITY Tracy IN. 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 CCR 2632,2634 2638 2641 MONITORING EQUIPMENT IS SERVICED 1.ANNUALLY [] 99.OTHER(Specify): 4�3p III.MONITORING LOCATIONS ❑� 1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. E 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 263/)49o-4 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 CONTAINMENTIS: ❑ a.DRY b.LIQUID FILLED ❑ c.PRESSURIZED E d.UNDER VACUUM 4904 PANEL MANUFACTURER: Veeder-Root 490-2 MODELP TLS-1450R 492 LEAK SENSOR MANUFACTURER: Veeder-Rout 490-9. MODEL#(S): 794380-303 49010 ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALI�TANWSI.(23 CCR§2643) 490-11 PANEL MANUFACTURER 490"12' MODEL q: 490'13 IN-TANK PROBE MANUFACTURER: 490'14' MODEL#(S): - 490'15 LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILYINIGHTLY ❑ a WEEKLY 49016 ❑ d.MONTHLY ❑ c.OTHER(Specify): 490'17 PROGRAMMED TESTS: ❑ a.0.1 g.p.h. ❑ b.0.2 g.p.h. ❑ e.OTHER(Specify): 490-18 49019 ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 49020 ❑ 4.WEEKLY MANUAL TANK GAUGING(ATG)(23 CCR§2645). TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS 4921 490,22 S.TANK INTEGRITY TESTING(23 CCR§2643.1): 490-23 TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY E c.OTHER(Specify): 49U25 ❑ 99.OTHER (Specify): 49026 490,27 V.PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S)(Check aR that apply) 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 4928 VISUAL ALARMS. (23CCR§2636) SECONDARY CONTAINMENT IS:[Ea.DRY Eb.LTQUID FILLED [1c.PRESSURIZED Wd.UNDER VACUUM 490¢9 PANEL MANUFACTURER: Veeder-Rom 490-30 MODEL#: TIS-35oR 49x1 LEAK SENSOR MANUFACTURER Veeder-Root 490-32 MODEL#(S): 794380-323,794360-3D4.657280-100 490-33 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. N a.YES ❑b.NO 490'34 FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ®a.YES ❑b.NO 49x35 2.MECHANICAL LINE LEAK DETECTOR(MLLD)THAT ROUTINELY PERFORMS 3.0 gp.b.LEAK TESTS AND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK IS DETECTED(23 CCR§2636) _ _ 490-36 MLLD MANUFACTURER(S): FE Petro 490.17 MODEL#(S): STP-MLD-D 490'18 ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS (23 CCR§2636) 49039 ELLD MANUFACTURER(S) 490-40. MODEL#(S): 49041 PROGRAMMED IN LINE LEAK TEST: ❑ 1.MINIMUM MONTHLY 0.2 g.pb. ❑ 2.MINIMUM ANNUAL 0.1 g.p.h. 49042 ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 45043 ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 49044 ❑ 4.PIPE INTEGRITY TESTING 49o4s TEST FRE UENCY ❑ &ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(Specify) 4904649047 5.VISUAL PIPE MONITORING. 49040- FREQUENCY ❑ a DAILY ❑ b.WEEKLY ❑a MIN.MONTHLY&EACH TDa SYSTEM OPERATED* 49049 •AlloaW formoui o[uvbudad oma w¢a[m reel I19C 2528L5 ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR§2636(a)(3)]. 490-50 ❑ 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7]IS CONNECTED TO THE TANK SYSTEM 490-51 ❑ 99.OTHER(Specify) 49asz 49053 UPCF UST-D(12/2007)1/4