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).. low UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN — Pae 1 of 2) TYPE OF ACTION ❑ I.NEW PLAN ❑ 2.CHANGE OF INFORMATION '"x1 PLAN TYPE I.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY (Check one iter,only) ❑ 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): I. FACILITY INFORMATION FACILITY IDA(.4genev Use Only) 1 O — 3 1 I BUSIN�FsS NAME,,((Some as Facility Nmne or DBA) 3 K-IJ6Z BUSTESSSITEADDRESS 1113 CITY IN qfl14 STbCv_rc J I . EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE Testing,preventive maintenance,and calibration of monitorme equipment(e.g.,sensors,probes,line leak detectors,etc.)must be performed at the frequency specified by the.equipment manufacturers'instructions,or annually.��hichever is more frequent Such work must be performed by qualified personnel j23CCR§132 VJ,I.sox.2611 1Hi MONITORING EQUIPMENT IS SERVICED &I ANNUALLY ❑ 99.OTHER(Specify): x11-3e III. MONITORING LOCATIONS ❑ I,NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN K 2,SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED 123 CCR 4265±.26341 IV. TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) tha/tak lv) I.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) -61 WITH AUDIBLE AND VISUAL ALARMS.123 CCR§x.32.265+1 SECONDARY CONTAINMENT IS: 9a.DRY [IDRY b.LIQUID FILLED ❑ C.PRESSURIZED ❑ d.UNDER VACUUM pW PANEL MANUFACTURER: IIJA-1' 3 4'"1-7 MODEL#: X—I V;- LEAK SENSOR MANUFACTURER: 1201)hr3 MODEL#(S): LS 3 '"x10 ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).R3 ccR g±6431 PANEL MANUFACTURER. ""412 MODEL#. 4,X>•ls IN-TANK PROBE MANUFACTURER: 41114 MODEL#(S): "xxls LEAK TEST FREQUENCY. ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY J1"6 ❑ d.MONTHLY ❑ e.OTHER(Specify): N PROGRAMMED TESTS: ❑ a 0.1 g.ph b O'gph. ❑ c.OTHER(Specify):__ ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION 1n CCR§-64611 xwldn ❑ 4.WEEKLY MANUAL TANK GAUGING(M-1'G)125 CCR§21451 TESTING PERIOD. ❑ a.36 HOURS ❑ b.60 HOURS 441x, ❑ 5 TANK INTEGRITY TESTING PER 123 CCR§2643 11 TEST FREQUENCY. aANNUALLY ❑ bBIENNIALLY ❑ c.OTHER(Specify): .�.. ❑ 99.OTHER(Specify): 4'ID.,7 V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) na;appW `k I.CONTINUOUS MONITORING OF PIPE/PIP[NG SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE&VISUAL ALARMS 41`19 I' CCR SECONDARY CONTAINMENT IS: ® a.DRY C] b.LIQUID FILLED ❑ c.PRESSURIZED [Id.UNDER VACUUM ""`21 �I � �- PANEL MANUFACTURER: 9-L* � 1 )AN 41130. MODEL#: X'1(0) 4,X.31 LEAK SENSOR MANUFACTURER: RAIJ" 4'X'32 MODEL#(S): L's-S ""''33 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. ❑ a.YES 19 b.NO 411.34 FAILURE(DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES J9 b.NO 4'x1-15 Ut 2.MECHANICAL LINE LEAK DETECTOR(MECO)THAT ROUTINELY PERFORMS 3.0 g h LEAK TESTS AND RESTRICTS OR SHUTS OFF 4"116 PRODUCTFLOW WHEN A LEAK IS DETECTED 123CCR§26161 xSua] MELD MANUFACTURER(S). G orry0 MODEL#(S): STIMIA 41131 �STPM V6 ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS.123 CCR§2e361 ELLD MANUFACTURER(S)'. J1W0 MODEL#(S): PROGRAMMED IN LINE LEAK TEST: ❑ a.MINIMUM MONTHLY 0.2 g.p.It ❑ b MINIMUM ANNUAL 0.1 g.p.h, ELIO DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ❑ b.NO ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES [I b.NO 411 ® 4.PIPE INTEGRITY TESTING. +•xu5 _ TES'T FREQUENCY 0 a.ANNUALLY C1 b.EVERY 3 YEARS C] c.c.OTHER(Specify) _4!1 7 ❑ 5.VISUAL PIPE MONnfoRING. FREQUENCY'. ❑ a.DAILY ❑ b.WEEKLY ❑ C.MIN.MONTHLY&EACH TIME SYSTEM OPERATED' 4'""49 'AIIoxW fl nwgilonngof wbunN smera :gmeruor fgel Plp^[.PN'.Pal.HSC§52x151643_)_ ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA.123CCR§263Nax311 4' 511 ❑ 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE.DIVISION 20,CHAPTER 6 7 IS CONNECTED TO THE TANK SYSTEM. 41x151 ❑ 99.OTHER(Specify) "14s3 sz UPCF UST-D(12/2007)-1/4 www.unldocs.org