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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN-(Page i of 2 TYPE OF ACTION ® 1.NEW PLAN ❑ 2-CHANGE OF INFORMATION 490.1 PLAN TYPE ® 1.MONITORING IS IDEN 1"1CAL FOR ALL USTs AT THIS FACILITY. 490-2 Check one item only) ❑ 2-THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S). L FACa.iTY INFORMATION:. FACILITY ID#(Agency Use Only) Ft BUSINESS NAME(Same as FACILITY NAME)Costco Tracy Gas Station#658 3. BUSINESS SITE ADDRESS 3250 West Grantline Road 100• CITY Tracy 104. H.EQUIPMENT-TESTING AND PREVENTIVE MAINTENANCE Testing,preventive maintenance,and calibration of monitoring equipment(e.g..sensors,probes,line leak detectors,eteJ must be performed at the frequency specified by the equipment manufacturers'instructions,or annually,whichever is mon frequent,and that such work must be performed by qualified personnel. (23 CCR 2632t2634,2638,2641) -- - -__........... - ----------- MONITORING EQUIPMENT IS SERVICED ® 1.ANNUALLY 492}3' ❑ 99.OTHER(Specify): 490-ja III.MONITORING LOCATIONS 1,NEW SITE PLOT PLANIMAP SUBMITTED Wl'TH THIS PLAN. C@ 2.SITE PLOT PLAN(MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 2634)49U-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 CONTAINMENT IS: ❑ a.DRY ® b.LIQUID FILLED ❑ c.PRESSURIZED [Id.UNDER VACUUM 490.6 - ------- - ---- ---- _ -_- PANEL MANUFACTURER: Vetder Root 49°"7 MODEL#: TLS,350R 4%4 -------- .....--------------- ----------- - - -....... - - LEAK SENSOR MANUFACTURER: VeederRaot 4°�9, MODEL#(S): 794380,301 490-10 El 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL-JAMES).(23 CCR§2643) 490-11 PANEL MANUFACTURER: 490.12. MODF1.#: 490-13 TN-TANK PROBE MANUFACTURER: a90-2a. MODEL#(S): 44°t5 LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ C.WEEKLY ago to ❑ d.MONTHLY e.OTHER S eci ): 490-17 PROGRAMMED TESTS: ❑ a.0.1 gp.h ❑ b.0.2 g.p.h. Q c.OTHER(Specify): 4ggajq ❑ 3.MONTHLY STATISTICAL E VENTORY RECONCILIATION(23 CCR§2646.1): 47WIF ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§2645), TESTING PFRIOD; ❑ a,36 HOURS [3b.60 HOURS +40-22 490-22 S.TANK INTEGRITY TESTING(23 CCR 12643.1): 490-23 9 0. TEST FREQUENCY: C3 a.ANNUALLY ❑ b.BIENNIALLY El e.OTHER(Specify): 40-24 9°-z5 ❑ 99.OTHER (Specify): 490-26 490.27 V.PIPE MONITORING IS PERFORIMED USING THE FOLLOWING METHOD(S)(Cheek all that apply) 1.CONTINUOUS MONITORING OF PIPE!PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 490.2E VISUAL ALARMS. (23 CCR§2636) SECONDARY CONTAINMENT IS:Oa.DRY ❑b.LIQUID FILLED ❑c.PRESSUR[Z.ED ❑d.UNDER VACUUM 490.29 -------------------------------------- ---------------- ------ --- ----------------------------- PANEL MANUFACTURER:Vender Root(VR) '9c 1tl MODEL#: 71.5 35OR 490-31 ------------------------------------ -------------------- ---------- ---------- ------------------------------ LEAK SENSOR MANUFACTURER: VR sump interior 490 32 MODEL#(S): 794380.352 490.33 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. IS a.YES b.NO 490.34 FAILUREIDISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ®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 CCR§26316 - - ----- MLLD MANUFACTURER(S):Red Jseket.Vaporless 490.37 MODEL#(S): FXZV.LD2Ub0 440"31 ❑ 3.ELECTRONIC LINE LEAK DETECTOR(EL LD)THAT ROUTINELY PERFORMS 3.0 g.p.lL LEAK TESTS (23 CCR 12636) 490-39 ELLDMANUFACTURER(S) 491}40. _M(3DEI.#(S): 490.41 _-PROGRAMMED IN LINE LEAK TEST-- ©"1.MINIMUM MONTHLY 0.2 g.p,h. ❑ 2,MINIMUM ANNUAL 0.1 g.p.h. 490-42 ELLD DEFECTION OFA PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 4W43 ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑s.YES ❑b.NO 490M 4.PIPE fNTEGRITY TESTING 49c.4s TEST FREQUENCY 0 a.ANNUALLY 0 b.EVERY 3 YEARS c.OTHER(Specify) 490.4649047 3.VISUAL PIPE MONITORING. 490.49 FREQUENCY 0 a.DAILY ❑ b.WEEKLY ❑C.MtN.MONTHLY a EACH TIME SYSTEM OPERATED* 49049 'AUo-od far mmmr=a ems cmc eoeretor fu4 uioiuaa1v=HSV 425291, J� ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR 12636(•)(3)1. 4901" 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM 490-51 [352 IN.OTHER(Spccify) '909-I UPCF UST-D(IZrMO7)INN