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UNIFIED PROGRAM CONSOLIDATED FORMOW UNDERGROUND STORAGE TANK MONITORING PLAN-(page 1 of 2) TYPE OF ACTION ❑1.NEW PLAN ❑ 2.CHANGE OF INFORMATION 490.1 PLAN TYPE ❑ 1.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. 490.2 (Check one item only) ❑ 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S)- I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) 1 BUSINESS NAME(Same as FACILITY NAME) A „�e CQ l; 0 S 3. BUSINESS SITE ADDRESS I?j 0 N M • S 103 CITY M A 0,}e C� (4 la. IL EQUIPMENT TESTING AND PREVENTIVE MAWMANCE Testing,preventive maintenance,and calibration of monitoring equipment(e.g.,sensors,probes,line leak detectors,etc.)must be perfomled 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 2632 2634 2638 2641 MONITORING EQUIPMENT IS SERVICED ❑ 1.ANNUALLY ❑ 99.OTHER(Specify): 490.3' . _. 490.36 M.MONITORING LOCATIONS ❑1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. ❑2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 2634)490.4 IV.TANK MONITORING IS PERFORMED USINGTHE FOLLOWING METHOD(S): I.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT 490.5 VAULT(S)WITH AUDIBLE AND VISUAL ALARMS. (23 CCR§2632,2634) SECONDARY CONTAINMENT IS: a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED ❑d.UNDER VACUUM, 0904 PANEL MANUFACTURER: 4i 4A 2✓ 490'3. MODEL LEAK SENSOR MANUFACTURER a90a. I MODEL#(S): 1,S o 690.10 Lj 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S),(23 CCR§2643) 490.11 PANEL MANUFACTURER: 490'12 MODEL#: 490-13 IN-TANK PROBE MANUFACTURER: 090.14 MODEL#(S): •Salt LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ C.WEEKLY 490.16 ❑ d.MONTHLY ❑ e.OTHER(Specify): 49x13 PROGRAMMED TESTS: ❑ a.0.1 g.p.h. ❑ b.0.2 g.p.h. ❑ c.OTHER(Specify): 4a1a ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 490.19 ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§2645). TESTING PERIOD: ❑ a 36 HOURS ❑ b.60 HOURS 490.31 Lj S.TANK INTEGRITY TESTING(23 CCR§2643.1): 21 4990-v TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): 49°14 4W0. ❑99.OTHER (Specify): 490-M 490.2] V.PIPE MONITORING IS PERFORMED USING THE FOLLOWINGMETHOD(S)(Check all that apply) 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 490.28 VISUAL ALARMS. (23 CCR§2636) i SECONDARY CONTAINMENT IS: DRY ❑b.LIQUIDFILLED ❑c.PRESSURIZED ❑d.UNDER VACUUM 490-39 �ANEL MANUFACTURER V 2 -GY 690'30 MODEL#: (, S to 2 ea 69°'31 `' EAK SENSOR MANUFACTURER E 2p j eV L5m(- 490'33 MODEL#(S): a rJ 49°-33 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. 13 a YES ❑b.NO °90.11 FAILUREIDISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ®a.YES ❑b.NO 49°x5 2.MECHANICAL LINE LEAK DETECTOR(MILD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS AND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK IS DETECTED 23 CCR26 490.M MLLDMANUFACTURERS): E "P a. ,� o YD 490,13 MODEL#(S): icy, 'J M 490.3e ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.pJL LEAK TESTS (23 CCR§2636) 490-39 ELLD MANUFACTURERS) 49040 MODEL#(S): 49041 PROGRAMMED IN LINE LEAK TEST: ❑ 1.MINIMUM MONTHLY 0.2 g.p.h. ❑ 2.MINIMUM ANNUAL 0.1 g.pA 491N2 ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 490<3 ELLDFAILUREMISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑&YES ❑b.NO d9660 $.PIPE INTEGRITY TESTING 49x15 TEST FREQUENCY 0 a.ANNUALLY Q b.EVERY 3 YEARS Q c.OTHERS 49045~ Lj S.VISUAL PIPE MONITORING. 490x5 FREQUENCY ❑ a.DAILY ❑ b.WEEKLY ❑C.MIN.MONTHLY&EACH TIME SYSTEM OPERATED- 410.49 .•Allowed fire monitor oFimbuded eeentor bur i'n oN HSC 28391.5 3) ❑ §.SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR§2636(1)(3)(. 490-50 7:NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.71S CONNECTED TO THE TANK SYSTEM 490. I ❑ 1!09.OTHER(Specify) 49052 490.53 UPCF UST-D(12/2007)1/4