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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN- e 1 of 2) TYPE OF ACTION ❑1.NEW PLAN ® 2.CHANGE OF INFORMATION 4961 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): L FACILITY INFORMATION FACILITY ID#(Agency Use Only) I I I1 BUSINESS NAME(same as FACLITY NAME)COSTCO WHOLESALE GAS STATION#658 BUSINESS srm ADDRESS 3250 W GRANT LINE ROAD 03 crrr TRACY 104 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 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): 4963° 490.36 III.MONITORING LOCATIONS ® I.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. ❑2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 2634)4Sow 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 VAULTS)WITH AUDIBLE AND VISUAL ALARMS. (23 CCR§2632,2634) SECONDARY CONTAINMENT IS: ❑ &DRY E b.LIQUID FILED ❑ c.PRESSURIZED ❑d.UNDER VACUUM 490.6 PANEL MANUFACTURER: VEEDER ROOT 4967. MODEL#: TLS-350 4968 LEAK SENSOR MANUFACTURER: VEEDER ROOT 4969' 1 MODEL#(s): 794380-301 490.10 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).(23 CCR§2643) 490.11 PANEL MANUFACTURER: 49612. MODEL#: 49013 IN-TANK PROBE MANUFACTURER: 49°14 MODEL#(S): 49615 LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY 49x16 ❑ d.MONTHLY ❑ e.OTHER(Specify): 49617 PROGRAMMED TESTS: ❑ a.0.1 g.p.h. ❑ b.0.2 g.p.h. ❑ c.OTHER(Specify): 49018 49619 ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 49620 ❑ 4.WEEKLY MANUAL TANK GAUGING(MIG)(23 CCR§2645). TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS 49621 490.22 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 4WM TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): 49624 49625 ❑99.OTHER (Specify): 49626 49627 V.PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S)(Check aR that apply) 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMPS)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 490-28 VISUAL ALARMS. (23 CCR§2636) SECONDARY CONTAINMENT IS:Ea.DRY ❑b.LIQUID FILLED []c.PRESSURIZED ❑d.UNDER VACUUM 4WN PANEL MANUFACTURER:VEEDER ROOT 4963° MODEL#: TLS-350 49631 LEAK SENSOR MANUFACTURER: VEEDER ROOT 490'32 I MODEL#(s): 794380-352; 49633 793380-208 91 FELL PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. E&YES ❑b.NO 49634 FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. E&YES ❑b.NO 49635 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§2636) 49636 MLLD MANUFACTURER(S): 490-37 MODEL#(S): 49638 E 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p h.LEAK TESTS (23 CCR§2636) 49639 ELLD MANUFACTURER(s)VEEDER ROOT 490-40' MODEL#(S): PLLD 49°41 PROGRAMMED IN LINE LEAK TEST: ❑ 1.MINIMUM MON'T'HLY 0.2 g.p.h. ❑ 2.MINIMUM ANNUAL 0.1 g.p.h. 49642 ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. E a.YES ❑b.NO 490x3 FI I FAD.UREMISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. E a.YES ❑b.NO 49644 4.PIPE INTEGRITY TESTING 4964s TEST FREQUENCY ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHERS i 4904649647 Lj S.VISUAL PEPE MONITORING. 49a4S FREQUENCY ❑ a.DAILY ❑ b.WEEKLY ❑C.MIN.MONTHLY&EACH TIME SYSTEM OPERATED- 49649 •Apowd for vuMo' of uobwi ie evere,w fuel i m od HSC 25291.56 3 ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA[23 CCR§2636(a)(3)]. 49650 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM 49651 ❑ 99.OTHER(Specify) 490.52 490.53 Belshire Environmental Services,Inc.