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r UNDERGROU`(D STORAGE TANK MONwI'ORING PLAN For use by Unidocs Member Agencies or where approved by your Local Jurisdiction Authority Cited: Title 23 CCR, Sections 2632(d)(1), 2634(d)(2), and 2641(h) Mol. TYPE OF ACTION ❑ 1.NEW PLAN ® 2.CHANGE OF INFORMATION PLAN TYPE ® MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. Moz. (Check one item only) ❑ THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) - - FACILITY NAME 7-Eleven#17334 Moa. FACILITY SITE ADDRESS 4501 N. Pershing Mao CITY Stockton mos. IL EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE State law requires that testing,preventive maintenance,and calibration of monitoring equipment(e.g.,sensors,probes,line leak detectors,etc.)be performed in M06. accordance with the equipment manufacturers'instructions,or annually,whichever is more frequent. Such work must be perfortned by qualified personnel. M07.MONITORING EQUIPMENT IS SERVICED ® 1.ANNUALLY [199.OTHER(Specify): III. MONITORING LOCATIONS 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 diagram(e.g.,current UST Monitoring Site Plan from a Monitoring System Certification form,Haeardous Materials Business Plan map,etc.)which shows all required information,include it with this plan. IV. TANK MONITORING MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S):(Check all that apply) Mlo. ® 1.CONTINUOUS ELECTRONIC MONITORING OF TANK ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) SECONDARY CONTAINMENT IS: ❑ a.DRY ® b.LIQUID FILLED ❑ c.I INDER PRESSURE ❑ d.UNDER VACUUM MD. PANEL MANUFACTURER: VeederROot 2. MOD #: TLS350 M13. LEAK SENSOR MANUFACTURER: VBeerROot 14. MODE #(S): 794390-420 M15. ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(Sl PANEL MANUFACTURER: M6. MO L#: MIT IN-TANK PROBE MANUFACTURER: Is. M EL#(S): MM LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.D Y HTLY ❑ c.WEEKLY M2°. ❑ d.MONTHLY ❑ e.O (Specify): M21. PROGRAMMED TESTS: ❑ a. .h. ❑ b.0.2 .p.h. ❑ c.0 ER(Spmify): M22. Mz3. ❑ 3.INVENTORY RECONCILIATION ❑ a. AN L PER 23 CCR§26 ❑ b.STATISTICAL PER 23 CCR§2646.1 W4. ❑ 4.WEEKLY MANUAL TANK GAUGING(M G)PE 23 CCR§2645 TESTING PERIO ❑ a.' HOU E] b.60 HOURS W5, E] 5.INTEGRITY TESTING ER 23 CCR§2643.1 TEST FREQUENC ❑ a.A UAL ❑ b.BIENNIALLY [I c.OTHER(Specify): M26. WT El NE: Ela.DAI Y ❑ b.WEEKLY(RNoim,8.,apprurnq ❑ 99.OTHER(Specify): Mza. V. PIPE MONITORING MONITORING S PERFORME USING THE FOLLOWING METHOD(S)(Check all that apply) Mao. ® 1.CONTIN US ELECTR NIC MONITORING OF PIPING SUMP(S)/TRENCH(ES)AND OTHER SECONDARY CONTAINMENT SECON ARY CON AINMENT IS: ® a.DRY ❑ b.LIQUID FILLED ❑ c.UNDER PRESSURE ❑ d.UNDER VACUUM M31. PANEL UFAC RER:VeederRoot M32. MODEL#: TLS350 MJ3- LEAKSENS M UFACTURER: VeederROot M34. MODEL#(S): 794380-352 W5. WILL A PIPIN AK ALARM TRIGGER AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN? ® a.YES ❑ b.NO MDs. WILL FAILUR&DISCONNECTION OF THE MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? ® a.YES ❑ b.NO Mar. ® 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 MLLD MANUFACTURER(s):Vaporless &Redlacket Mas. MODEL#(S): LD2000&FX1 V M39. ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS ELLD MANUFACTURER: Moo. MODEL#: M41. PROGRAMMED LINE INTEGRITY TESTS: ❑ a.MINIMUM MONTHLY 0.2 g.p.h. ❑ b.MINIMUM ANNUAL 0.1 g.p.h. M42. WILL ELLD DETECTION OF A PIPING LEAK TRIGGER AUTOMATIC PUMP SHUTDOWN? ❑ a.YES ❑ b.NO M43. WILL ELLD FAILURFIDISCONNECTION TRIGGER AUTOMATIC PUMP SHUTDOWN? ❑ a.YES ❑ b.NO M44. ® 4.INTEGRITY TESTING TEST FREQUENCY: ® a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(Specify) M45. M46. ❑ 5.VISUAL MONITORING DONE: ❑ a.DAILY ❑ b.WEEKLY- ❑ C.MIN.MONTHLY&EACH TIME SYSTEM OPERATED'" M47. •Requim as.,approwl "Allowed for monitoring of unburie i con tgency ge or fuel piping only per HSC§25281.5(b)(3) ❑ 6.PIPING IS SUCTION PIPING MEETING ALL REQUIREMENTS FOR EXEMPTION FROM MONITORING PER 23 CCR§2636(a)(3) ❑ 7.NO PRODUCT OR REMOTE FILL PIPING IS CONNECTED TO THE UST(s) ❑ 99.OTHER(Specify) Mos. UN-022A-I/3 www.unldocs.org Rev.IOA4103