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AOL <br />.. <br />UNIFIED PROGRAM CONSOLIDATED FORMdw <br />UNDERGROUND STORAGE TANK <br />MONITORING PLAN - Pae I of 2) <br />TYPE OF ACTION [11. NEW PLAN A2. CHANGE OF INFORMATION <br />41 <br />PLAN TYPE x 1. MONITORING IS IDENTICAL FOR ALL USTS AT THIS FACILITY. <br />490.2 <br />(Chak one item only) ❑ 2. THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S) <br />L FACILITY INFORMATION <br />FACILITY ID # (Agency Use Only) - - <br />I <br />BUSINESS NAME (Same as FACILITY NAME) c' T <br />3. <br />BUSINESS SITE ADDRESS 5��7 E Gh S/. 103 <br />CITY <br />U. EQUIPMENT TESTING AND PREVENTWE MAINTENANCE <br />Testing, preventive maintenance, and calibration of monitoring equipment (e.g., sensors, probes, have leak detectors, etc.) must be perfumed at the frequency <br />specified by the equipment manufacturers' instructions, or annually, whichever is more frequent, and that such work must be performed by qualified personnel. <br />23 CCR §2632,2634, 2638 2641 <br />MONITORING EQUIPMENT IS SERVICED 1. ANNUALLY ❑ 99. OTHER (Specify): <br />49 3b <br />DI. MONITORING LOCATIONS <br />❑ 1. NEW SITE PLOT PLANIMAP SUBMITTED WITH THIS PLAN.AL SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR §2632, <br />2634)49oa <br />IV. TANK MONITORING L4 PERFORMED USINGTHE FOLLOWING METHOD(S): <br />1. CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR (DYFERSTITIAL) SPACE(S) OR SECONDARY CONTAINMENT <br />490'5 <br />VAULT(S) WITH AUDIBLE AND VISUAL ALARMS. (23 CCR §2632,2634) <br />SECONDARY CONTAINMENT IS: ❑ a. DRY X b. LIQUID FILLED ❑ c. PRESSURIZED ❑ d. UNDER VACUUM <br />49°E <br />PANEL MANUFACTURER: 490.1. MODEL #: <br />4904 <br />LEAK SENSOR MANUFACTURER: �^ ° MODEL #(S): / j -��;, <br />490.10 <br />2. AUTOMATIC TANK GAUGING (ATG) SYSTEM USED TO MONITOR SINGLE WALL TANKIS). (23 CCR §2643) <br />490.1 <br />PANEL MANUFACTURER: 490.12 MODEL #: <br />490.13 <br />IN -TANK PROBE MANUFACTURER: 090.10- MODEL #(S): <br />490.15 <br />LEAK TEST FREQUENCY: ❑ a CONTINUOUS ❑ b. DAI.YMIGHTLY ❑ c. WEEKLY <br />490.16 <br />❑ d. MONTHLY ❑ e. OTHER (Specify): <br />49x17 <br />PROGRAMMED TESTS: Ela. 0.1 g.p.h. [Ib. 0.2 g.p.h. ❑ c. OTHER (Specify): <br />490.19 <br />❑ 3. MONTHLY STATISTICAL INVENTORY RECONCILIATION (23 CCR §2646.1): <br />°90.3D <br />❑ 4. WEEKLY MANUAL TANK GAUGING (MTG) (23 CCR §2645). TESTING PERIOD: ❑ a. 36 HOURS ❑ b. 60 HOURS <br />490.21 <br />490.22 <br />5. TANK INTEGRITY TESTING (23 CCR §2643.1): <br />49 v <br />TEST FREQUENCY: ❑ a. ANNUALLY ❑ b. BIENNIALLY ❑ c. OTHER (Specify): <br />49 <br />❑ 99. OTHER (Specify): <br />49W6 <br />490.27 <br />V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD($) (Check all that apply) <br />XI . CONTINUOUS MONITORING OF PIPE/ PIPING SUMPS) AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND <br />°90'rs <br />VISUAL ALARMS. (23 CCR §2636) <br />16 <br />SECONDARY CONTAINMENT IS: XQ DRY ❑b. LIQUID FILLED ❑c. PRESSURIZED ❑d UNDER VACUUM <br />490'39 <br />PANEL MANUFACTURER: H 490.3° MODEL #: <br />49 11 <br />LEAK SENSOR MANUFACTURER: 490.13 MODEL fI(S): s L,� <br />49033 <br />PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP (i.e., TURBINE) SHUTDOWN. ❑ a. YES 91b. NO <br />4WU <br />FAILUREMISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ st YES Xb. NO <br />49W5 <br />2. MECHANICAL LINE LEAK DETECTOR (M LD) THAT ROUTINELY PERFORMS 3.V.pj LEAK TESTSAND RESTRICTS OR SRUTS I F,/ <br />UK <br />PRODUCT FLOW WHEN A LEAK IS DETECTED 23 CCR 26 1-I' t i -L gnnrt1',,ii <br />90'76 <br />MLLDMANUFAC URER(S): A-I'P497`' 490.31 MODEL#(S): nif�%�. SrP-IKLO <br />❑ 3. ELECTRONIC LINE LEAK DETECTOR (ELLD) THAT ROUTINELY PERFORMS 3.0 g.ph. LEAK TESTS (23 CCR §2� <br />490.39 <br />ELLD MANUFACfURER(S) 49040. MODEL #(S): <br />49 11 <br />PROGRAMMED IN LINE LEAK TFST: ❑ 1. MINIMUM MONTHLY 02 g.p.h. ❑ 2. MINIMUM ANNUAL 0.1 g.p.h. <br />490-2 <br />ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a. YES ❑ b. NO <br />490'43 <br />ELLD FAILURE/DISCONNECrION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a. YES ❑ b. NO <br />09 <br />4. PIPE INTEGRITY TESTING 49 s <br />TEST FREQUENCY IR a. ANNUALLY b. EVERY 3 YEARS c. OTHERS i 4904649047 <br />5. VISUAL PIPE MONITORING. <br />49 <br />FREQUENCY ❑ a. DAILY ❑ b. WEEKLY ❑ c. MM. MONTHLY A EACH TIME SYSTEM OPERATED- <br />490x9 <br />•Aame3 tar momWm, of mk;Lmd fad ripitt,i, only W HSC W23 13(b)(3) <br />❑ 6. SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR §2636(ax3)1• <br />490'50 <br />7. NO REGULATED PIPING PER HEALTH AND SAFETY CODE, DIVISION 20, CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM <br />490.51 <br />90.5$ <br />❑ 99. OTHER (Specify) <br />49o-53 <br />UPCF UST -D (1212007) 114 <br />