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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN-(Page I of 2) TYPE OF ACTION 1.NEW PLAN2.CHANGE OF INFORMATION 4901 PLAN TYPE ,. 1.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. 490Q (Check one item only) ❑ 2.TMS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(SL I. FACII.ITY INFORMATION FACILITY ID#(Agency Use Only) ,tel BUSINESS NAME(Same as FACILITY NAME) S'�YE OA/ q(,,r�7 f- ,C1 ) BUSINESS SITE ADDRESS 4a F I/V OS�E�/Y)17� i/I/� to3 C� men11C C ./ uw. 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 42632,2634,2638 2641 MONITORING EQUIPMENT IS SERVICED I.ANNUALLY El 99,OTHER(Specify): 4%3b III.MONITORING LOCATIONS ❑1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN..SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 2634)49oa IV.TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT 49-5 VAULTS)WITH AUDIBLE AND VISUAL ALARMS. (23 CCR§2632,2634) SECONDARY CONTAINMENT IS: a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED ❑d.UNDER VACUUM 49P6 PANEL MANUFACTURER: OrMAU7EG 490.1. MODEL#: Oct_-7000 4908 LEAK SENSOR MANUFACTURER: or)?NTEL 490.4. MODEL#(S): tWG-et` 490.10 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANKIS).(23 CCR§2643) 490-11 PANEL MANUFACTURER: 49-12. MODEL#: 49-13 IN-TANK PROBE MANUFACTURER: 09016 MODEL#(S): 49-15 LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILYINIGHTLY ❑ c.WEEKLY 49°'16 ❑ d.MONTHLY ❑ e.OTHER(Specify): 44-17 49-18 PROGRAMMED TESTS: ❑ a.0.1 g.p.h. ❑ b.0.2g.p.h. ❑ c.OTHER(Specify): 49x19 ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 490.20 ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§2645). TESTING PERIOD: ❑ a.36 HOURS [Ib.60 HOURS ay921 n 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 490.23 TEST FREQUENCY: ❑ &ANNUALLY ❑ b.BILNINIALLY ❑ c.OTHER(Specify): 49-24 490.25 ❑99.OTHER (Specify): 490 26 49-26 V.PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 49-28 VISUAL ALARMS. (23 CCR§2636) SECONDARY CONTAINMENT IS:,5k.DRY ❑b.LIQUID FILLED ❑c.PRESSURIZED ❑d.UNDER VACUUM 490.29 PANEL MANUFACTURER: All 7 C a9-3o MODEL - Of7O 49-31 LEAK SENSOR MANUFACTURER: O✓hNTEL 90 432 M #(S): -ODEL C 490.33 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. ❑a YES ❑b.NO 49-34 FAILUREIDISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a YES ❑b.NO 490.35 jjjj 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 23 CCR 49-36 MLLD MANUFACTURER(S): V+�PaIL�ESS E E?A20 m 29 MODEL#(5): q'q G3 Zptltl °ML a9-3e ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT RO INELY PERFORMS 3.0 gp.h.LEAK TESTS (23 CCR§2636) 490.39 ELLD MANUFACTURERS) °90'10 I MODEL#(S): 490-1 PROGRAMMED IN LINE LEAK TEST: ❑ 1.MINIMUM MONTHLY 0.2 g.p.h. ❑ 2.MINIMUM ANNUAL 0.1 g.p.h. 49-42 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 490'44 4.PIPE INTEGRITY TESTING 49045 TEST FRE UENCY ❑ &ANNUALLY ❑ b.EVERY 3 YEARS c.OTHERS i 490-0649049 ❑ 5.VISUAL PIPE MONITORING. 49048 FREQUENCY ❑ a.DAILY ❑ b.WEEKLY ❑C.MIN.MONTHLY&EACH TIME SYSTEM OPERATED- 49-49 •Allowed for monimn of unburied enaam fuel PIPORWYWHSC 281.5(b)(3) ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR§2636(6)(3)1• 49-50 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM 49-51 490-52 ❑ 99.OTHER(Specify) a9os3 UPCF UST-D(12/2007)1/4