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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUNDSTORAGETANK MONITORING PLAN-(Page 1 of 2) TYPE OF ACTION ❑1.NEW PLAN ❑ 2.CHANGE OF INFORMATION 4WD PLAN TYPE ❑ 1.MONITORING IS IDENTICAL FOR ALL UST'AT THIS FACILITY. 490,2 (Check one item only) ❑ 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEMS I. FACIIdTY INFORMATION FACILITY ID#(Agency Use Only) - - L{" 1 BUSINESS NAME(Same as FACILITY NAME) fc�ci5v A 3 BUSINESS SITE ADDRESS Z14142 nCUA IID. CITY e'}G r IM. IL EQUIPMENT TESTIN6 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 freque a,and that such work must be performed by qualified personnel. 23 CCR§2632,2634,2638 2641 MONITORING EQUIPMENT IS SERVICED 1.ANNUALLY ❑ 99.OTHER °9(134 (Specify): °90.36 IIL MONITORING LOCATIONS ❑1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. ®2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 2634)49(14 IV.TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACES)OR SECONDARY CONTAINMENT 49(15 VAULT(S)WITH AUDIBLE AND VISUAL ALARMS. (23 CCR§2632,2634) SECONDARY CONTAINMENT IS: aa.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED ❑d.UNDER VACUUM 09P4 PANEL MANUFACTURER: O7 ?00a 49(17' MODEL#: O o 4908 LEAK SENSOR MANUFACTURER ° MODEL#(S): 2.AUTOMATIC TANK GAUGING r4TG)SYSTEM USED TO MONITOR SINGLE WALL TANKIS).(23 CCR§264.7) 0(111 PANEL MANUFACTURER: 49(1Iz MODEL#: 490.13 IN-TANK PROBE MANUFACTURER: 49(114' MODEL#(S): 490"13 LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY 49(116 ❑ d.MONTHLY ❑ e.OTHER(Specify): 490.17 PROGRAMMED TESTS: E] a.0.1 g.p.h. ❑ b.0.2 g.p.h ❑ c.OTHER(Specify): 490.1849(119 ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 490,70 ❑ 4.WEEKLY MANUAL TANK GAUGING(MPG)(23 CCR§2645). TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS °9031 49(1n 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 49(123 TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): 490'34 49(125 99.OTHER (Specify): 4902U [3TESPa( fy: 49x17 V.PEPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 49(133 VISUAL ALARMS. (23 CCR§2636) SECONDARY CONTAINMENT IS:Ega.DRY ❑b.LIQUID FILLED ❑c.PRESSURIZED ❑d.UNDER VACUUM 49x39 PANEL MANUFACTURER MODEL#: _ go 49x31 LEAK SENSOR MANUFACTURER r 090'33 1 MODEL#(S): 0 49(133 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. ❑&YES ❑b.NO 49x34 FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑&YES ❑b.NO 49(125 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 f 49(136 MILD MANUFACTURER(S): -f'r 450.31 MODEL#(S): S 49°x6 ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS (23 CCR `) 49(139 ELLD MANUFACTURERS) 09P4p MODEL#(S): 49(141 PROGRAMMED M LINE LEAK TEST: ❑ 1.MINIMUM MONTHLY 0.2 g.p.h. ❑ 2.MIND"ANNUAL 0.1&Pti. 09043 ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑&YES ❑b.NO 4900 ELLD FAI.URF/DISCONNECrION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑&YES ❑Is NO 490'10 4.PIPE INTEGRITY TESTING 49 s TEST FREQUENCY 13 a ANNUALLY 0 b.EVERY 3 YEARS c.OTHER(Specify) K0.16H0.47 5.VISUAL PIPE MONITORING. 490.4 FREQUENCY ❑ a.DAILY ❑ b.WEEKLY �c.MIN.MONTHLY&EACH TIME SYSTEM OPERATED' 49049 'Aaowdfor mora of inbwid everuarfiW HSC 253'15 3 ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR§2636(x)(3)1• 490.50 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM 490-31 ❑ 99.OTHER(Specify) 49x53 UPCF UST-D(12/2007)1/4