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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUNDSTORAGETANK MONITORING PLAN- Page 1 of 2) TYPE OF ACTION L NEW PLAN ❑ 2.CHANGE OF INFORMATION 4�1 PLAN TYPE ❑ I.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. 4%2 (Check one item only) ❑ 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S) t�l�5 r1 L 7A/I L S I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) Ay SARP _ _ 1 BUSINESS NAME(Same as FACILITY NAME) TOYA�z ) 3. BUSINESS SITE ADDRESS VZ,() 0 A ./i 103. CITY LO j Ioa. 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 L ANNUALLY ❑ 99.OTHER490.3. (Specify): 490.36 III. ONIT G LOCATIONS ❑1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. .SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 2634)4904 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 A ARMS. (23 CCR§2632,2634) SECONDARY CONTAINMENT IS: a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED ❑d.UNDER VACUUM 49M PANEL MANUFACTURER: ode {Zta 'F 490-3 MODEL#: 'T'L 496s LEAK SENSOR MANUFACTURER: �/ � MODEL#(S): 79`13 O - 490'1° '❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).(23 CCR§2643) 1 49o-1I _PANEL MANUFACTURER: 4%-IZ MODEL#: 49°'13 IN-TANK PROBE MANUFACTURER: 490'14 MODEL#(S): 49ad5 LEAK TEST FREQUENCY: [Ia.CONTINUOUS Elb.DAILY/NIGHTLY ❑ c.WEEKLY 49616 _ ❑ d.MONTHLY _ _ ❑ e.OTHER(Specify): 490'13 PROGRAMMED TESTS: ❑ a.0.1 h. ❑ b.0.2 h. 49618 g.p.h. g.p.h. ❑ c.OTHER(Specify} 49619 ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 49620 ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§2645). TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS 49°-21 [_190-22 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 490-23 TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): 490'24 490-25 ❑99.OTHER (Specify): 49626 49627 V.PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 4�28 ISUAL ALARMS. (23 CCR§2636) SECONDARY CONTAINMENT IS: DRY ❑b.LIQUID FILLED ❑c.PRESSURIZED ❑d.UNDER VACUUM 4%-29 PANEL MANUFACTURER: e - fJ490"10 i MODEL#: T 490x1 LEAK SENSOR MANUFACTURER: V 49632 MODEL#(S):7 3 - Q 49633 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. a YES ❑b.NO 49x34 AILURE/DISCONNECTION 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 TES SAND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK IS DETECTED(23 CCR 2636 49°36 MLLDMANUFACTURER(S):1 111 TAC 49033 MODEL#(S):L ��VO PXIV -D 4963e ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS (23 CCR§2636)or 49639 ELLD M_ANUFACTURENS) 4904Q MODEL#(S): 49041 PROGRAMMED IN LINE LEAK TEST: ❑ 1.MINIMUM MONTHLY 0.2 g.p.h. ❑ 2.MINIMUM ANNUAL 0.1 g.p.h. 49042 ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 49043 ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 49044 ❑ 4.PIPE INTEGRITY TESTING49645 TEST FREQUENCY ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(Specify) 49646490.43 ❑ 5.VISUAL PIPE MONITORING. FREQUENCY E] a.DAILY [Ib.WEEKLY ❑c.MIN.MONTHLY&EACH TIME SYSTEM OPERATED- 4W49 -Allowed for m9Nbn duilnnedemcmcv R..w fuel piping odv im HSC 125281.5(b)(3) ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR§2636(a)(3)1• 490-50 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM 490-51 ❑ 99.OTHER(Specify) 49652 490.53 UPCF UST-D(12/2007)1/4