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f� SAN 7AQ10wi COUNTY ENVIRONMENTAL HEALTHb2PARTMENT UNDERGROUND STORAGE TANK MONITORING PLAN- PAGE 1 TYPE OF ACTION ❑ 1 2.CHANGE OF INFORMATION "101 PLAN TYPE MONITORING IS IDENTICAL FOR ALL LISTS AT THIS FACILITY. >102. (Check one item only) ❑ THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): LFACILITY INFORMATION FACILITY ID#(Agency Use Only) FACILITYNAME P6"We, 7 M03. FACILITY SITE ADDRESS ,q Z J 4 S p, rh Jill Rx M04. CITY Mos. IL EQUIPMENT TESTING AND PREVENTIVE MAINTENA CE State law requires that testing,preventive maintenance,and calibration of monitoring equipment(e.g.,sensors,probes,line leak detectors,etc.)be performed in Mos. accordancewith the equipment manufacturers'instructions,or annually,whichever is more frequent. Such work must be performed by qualifi d personnel. MONITORING EQUIPMENT IS SERVICED 5a_1.ANNUALLY 51-91 .. (Specify): °107 III. MONITORINGLOCATIONS This monitoring plan must include a Site Plan showing the general tank and piping layouts and the locations where monitoring is performed(i e,location of each sensor, line leak detector,monitoring system control panel,etc.). If you already have a diagran3(e.g.,current UST Monitoring Site Plan from a Monitoring System Certification form,Hazardous Materials Business Plan map,etc.)which shows all required information,include it with this plan. IV. TANK MONITORING MON[WRING IS PERFORMED USING THE FOLLOWING METIIOD(S):(Check that M Im CONTINUOUS ELECTRONIC MONITORING OF TANK ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) SECONDARY CONTAINMENT IS: a T b.LIQUID FILLED ❑ c.UNDER PRESSURE El d.UNDER VACUUM Mir. PANEL MANUFACTURER: Sire P I u"� -L D S "n" MODEL#: M13. LEAK SENSOR MANUFACTURER: 'CA 16dfml PDS M14. MODEL#(S): 4 3g�- 5OZ M15. AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TOM TUTOR SIT,tE'WRLCTI4SQI£fSlb .yryq{� PANEL MANUFACTURER: g M36. MODEL#: MIT IN-TANK PROBE MANUFACTURER: MIB. MODEL#(S): Mls. LEAK TEST FREQUENCY: ?.a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY Mm. ❑. d.MONTHLY ❑ e.OTHER(Specify): Mzl. PROGRAMMED TESTS: ❑ a.0.1 g.p.h. ❑. b..0.2 g.p.h. ❑ c.OTHER(Specify): ❑ 3.INVENTORY RECONCILIATION ❑. a.MANUAL PER 23 CCR§2646 ❑. b.STATISTICAL PER 23 CCR§2646.1 W4. [] 4.WEEKLY MANUAL TANK GAUGING(MIG)PER 23 CCR§2645 TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS M8. �(5.INTEGRITY TESTING PER 23 CCR§2643.1 TEST FREQUENCY: ❑ &ANNUALLY [Ib.BIENNIALLY 'JFe:OTHER(Specify): 5. WT .VISUAL MONITORING DONE: a.DAILY ❑ b.WEEKLY(treym.agency approval) ❑ 99.OTHER(Specify) 'fps : -n V. PIPE'MONITORING MONITORING IS PERFORMED USING TI IE FOLLOWING METTIOD(S)(Check all that apply) M30 -IS,L CONTINUOUS ELECTRONIC MONITORING OF PIPING SUMP(S)IrRENCH(ES)AND OTHER SECONDARY CONTAINMENT SECONDARY CONTAINMENT IS: 1,ate.DRY b.LIQUID FILLED ❑. c.UNDER PRESSURE [Id.UNDER VACUUM PANEL MANUFACTURER: Simq ae4�S _ pM" MODEL#: W3, LEAK SENSOR MANUFACTURER: Ir G DEIN CSI*7tODEL#(S): O - M35_ WILL A PIPING LEAK ALARM TRIGGER AUTOMATT PUMP(i.e.,TURBINE)SHUTDOWN? a YES ❑ b.NO Mas. WILL FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGER AUTOMATIC.PUMP SHUTDOWN? ,tea.YES ❑ b.NO Mn. ❑ 2.MECHANICAL LINE LEAK DETECTOR (MLLD) THAT ROUTINELY PERFORMS 3.0 &p.h. LEAK TESTS AND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK IS DETECTED MLLD MANUFACTURER(s): M38. MODEL#(S): 1,139. .ELECTRONIC LINE LEAK DET�E4VTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS \ g� ELLD MANUFACTURER: ) FE DEIZQon'I" K-LD M40' MODEL- d 1' 2 - M41_ PROGRAMMED LINE INTEGRITY TESTS: ❑ a.MINIMUM MONTHLY 0.2 g.p.h. ❑ b.MINIMUM ANNUAL 0.1 g.p.h. Max. WILL ELLD DETECTION OF A PIPING LEAK TRIGGER AUTOMATIC PUMP SHUTDOWN? YES ❑ b.NO sou WILL ELLD FAILUREIDISCONNECTION TRIGGER AUTOMATIC PUMP SHUTDOWN? �a.YES ❑ b.NO M44, K4.INTEGRITY TESTING TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS. ❑ c.OTHER(Specify) /,111/87ri4n nr L.,45 Mos. 1r5.VISUAL MONITORING DONE: fit_&DAILY ❑ b.WEEKLY- ❑ C.MIN.MONTHLY&EACH TIME SYSTEM OPERATED-- MQ. •Require vairy approval "Allowed for moniroring ofuni enrergmry gmveror fuel pipingoray per MC§252815(b)(3) ❑ 6.PIPING IS SUCTION PIPING MEETING ALL REQUIREMENTS FOR EXEMPTION FROM MONITORING PER 23 CCR§2636(ax3) ❑ 7.NO PRODUCT OR REMOTE FILL PIPING IS CONNECTED TO THE UST(s) ❑ 99.OTHER(Specify) Mae. SJCEHD-d(07/03)-1/4 07/23/03