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a <br />SJCEHD-d (07/03) - 1/4 07/23/03 <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />UNDERGROUND STORAGE TANK <br />MONITORING PLAN - PAGE 1 s� y <br />e <br />MOI. <br />TYPE OF ACTION ❑ 1. NEW PLAN 2. CHANGE OF INFORMATION <br />Moe. <br />PLAN TYPE MONITORING IS IDENTICAL FOR ALL USTS AT THIS FACILITY. <br />(Check one item only) [I THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): <br />I. FACILITY INFORMATION <br />FACILITY ID # (Agency Use Only) q <br />T <br />FACILITYNAME t 'Z4 2 G S <br />M04. CITY �` J' <br />FACILITY SITE ADDRESS �3 � W ZG <br />MOS. <br />R. EQUIPMEN TESTING AND PREVENTIVE MAINTENANCE <br />State law requires that testing, preventive maintenance, and calibration of monitoring equipment (e.g., sensors, probes, line leak detectors, etc.) be performed in <br />M06. <br />accordance with the equipment manufacturers' instructions, or annually, whichever is more frequent. Such work must be performed by qualified personnel. <br />Mal <br />MONITORING EQUIPMENT IS SERVICED X 1. ANNUALLY ❑ 99. OTHER (Specify): <br />III. MONITORING LOCATIONS <br />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, <br />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 <br />form Hazardous Materials Business Plan map, etc.) which shows all required information, include it with this plan. <br />IV. TANK MONITORING <br />MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): (Check all that apply) <br />M10. <br />1. CONTINUOUS ELECTRONIC MONITORING OF TANK ANNULAR (INTERSTITIAL) SPACE(S) OR SECONDARY CONTAINMENT VAULT(S) <br />M° <br />SECONDARY CONTAINMENT 1S: a. DRYo b. LIQUID FILLED ❑ c. UNDER PRESSURE ❑ d. UER VACUUM <br />�VS <br />Mt3. <br />�❑ <br />PANEL MANUFACTURER: - �cvi M12, MODEL #: TLS 3.SaND <br />LEAK SENSOR MANUFACTURER: V-gX49ti' M14.MODEL #(S): Y�.e <br />Mls' <br />❑ 2. AUTOMATIC TANK GAUGING (ATG) SYSTEM USED TO MONITOR SINGLE WALL TANK(S) <br />MV <br />PANEL MANUFACTURER: MODEL #: <br />M19. <br />IN -TANK PROBE MANUFACTURER: MIS. MODEL #(S): <br />M0' <br />LEAK TEST FREQUENCY: ❑ a. CONTINUOUS ❑ b. DAILY/NIGHTLY ❑ c. WEEKLY <br />❑ d. MONTHLY ❑ e. OTHER (Specify):� <br />PROGRAMMED TESTS: ❑ a. 0.1 g.p.h. [Ib. 0.2 g.p.h. ❑ c. OTHER (Specify): Mzz. <br />M23. <br />1713. INVENTORY RECONCILIATION [I a. MANUAL PER 23 CCR §2646 ❑ b. STATISTICAL PER 23 CCR §2646.1 <br />M1120' <br />❑ 4. WEEKLY MANUAL TANK GAUGING (MTG) PER 23 CCR §2645 <br />TESTING PERIOD: F1 a. 36 HOURS ❑ b. 60 HOURS <br />aus' <br />❑ 5. INTEGRITY TESTING PER 23 CCR §2643.1 M26. <br />M27. <br />TEST FREQUENCY: ❑ a. ANNUALLY ❑ b. BIENNIALLY ❑ C. OTHER (Specify): <br />❑ 6.VISUAL MONITORING DONE: ❑ a. DAILY ❑ b. WEEKLY (a quio s m -e eppmve> <br />M28. <br />❑ 99.OTHER (Specify): <br />V. PIPE MONITORING <br />MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply) <br />wo. <br />1. CONTINUOUS ELECTRONIC MONITORING OF PIPING SUMP(S)/FRENCH(ES) AND OTHER SECONDARY CONTAINMENT <br />SECONDARY CONTAINMENT IS: X a. DRY El b. LIQUID FILLED ❑ c. UNDER PRESSURE ❑ d. UNDER VACUUM <br />ml' <br />PANEL MANUFACTURER: Jt i:e.� (Lp�` Mas. MODEL #: TLS -73-0/ L US <br />W 5. <br />�s <br />LEAK SENSOR MANUFACTURER: ,1)-00-4 10n - ILodf W4. MODEL#(S): 208 �" _i <br />� a YES ❑ b. NO <br />W6. <br />WILL A PIPING LEAK ALARM TRIGGER AUTOMATIC PUMP (i.e., TURBINE) SHUTDOWN? <br />9f YES ❑ b. NO <br />M 7¢ <br />WILL FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? a. <br />❑ 2. MECHANICAL LINE LEAK DETECTOR (MLLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS AND RESTRICTS OR SHUTS <br />OFF <br />PRODUCT FLOW WHEN A LEAK IS DETECTED <br />W' MODEL #(S): 'D ZOGO i <br />Mlg. <br />MILLI) MANUFACTURER(s): M <br />ot 3. ELECTRONIC LINE LEAK DETECT OR �ELLD) THAT RO PERFORMS 3.0 g.p.h. LEAK TESTS t.e� <br />ELLD MANUFACTURER: �Mw. MODEL #: /�-` <br />M41. <br />M42. <br />PROGRAMMED LINE INTEGRITY TESTS: ❑ a. MINIMUM MONTHLY 0.2 g.p.h. ❑ b. MINIMUM ANNUAL 0.1 g.p.h. <br />WILL ELLD DETECTION OF A PIPING LEAK TRIGGER AUTOMATIC PUMP SHUTDOWN? Im a. YES ❑ b. NO <br />M43, <br />WILL ELLD FAILUREIDISCONNECTION TRIGGER AUTOMATIC PUMP SHUTDOWN? Q� a YES ❑ b. NO <br />M49' <br />❑ 4. INTEGRITY TESTING Mas. M46. <br />TEST FREQUENCY: [I a. ANNUALLY El b. EVERY 3 YEARS ❑ c. OTHER (Specify) <br />❑ SNISUAL MONITORING DONE: ❑ a. DAILY ❑ b. WEEKLY* ❑ c. MIN. MONTHLY & EACH TIME SYSTEM OPERATED" <br />•RN.msa8.gy Wprowl " Allowed for monitoringof unburied emergency Wirigor fuel piping only per HSC §25291,5(b)(3) <br />M47. <br />❑ 6. PIPING IS SUCTION PIPING MEETING ALL REQUIREMENTS FOR EXEMPTION FROM MONITORING PER 23 CCR §2636(a)(3) <br />❑ 7. NO PRODUCT OR REMOTE FILL PIPING IS CONNECTED TO THE UST(s) <br />Mae. <br />❑ 99. OTHER (Specify) <br />SJCEHD-d (07/03) - 1/4 07/23/03 <br />