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! 0 UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUNDSTORAGETANK MONITORING PLAN- (Pae 1 of 2) TYPE OF ACTION ❑ L NEW PLAN ❑ 2.CHANGE OF INFORMATION PLAN TYPE ® I.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. A90-2 [Check one nem only) ❑ 2.THIS PLAY COVERS ONLY THE FOLLOWING UST SYSTEM(S): I. FACILITY INFORMATION FACILI'CY Ill N(Agenry Use Oniy) i_ 13USINESS NAME(Sams as F=zfhy Name or DBA) Super Store Industries _3.. BUSINESS SITE ADDRESS 16888 McKinley Ave. tm. CITY Lathrop toa. 11. EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE Testing,preventive maintenance•and calibration of monitoring equipment(e.g.,sensors,probes,line leak detectors,etc.)most be performed at the Gcquency specified by the equipment mamrfamurers'inatmeti or annually,whichever is more Re wmr Such work must be pffficamed by qualified persannel.D3 c R§M 2,26.34,Mas,Mall MONITORING EQUIPMENT IS SERVICED ® 1.ANNUALLY ❑ 99.OTHER(Specify): a�3a' b. M. MONITORING LOCATIONS ' ❑ L NEW SITE PLOT PLAN.MAP SUBMITTED WITH THIS PLAN ® 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED4s0.�. Iz3 cux 3ze32,263at IV. TANK MONITORING IS PERFORMED:USING THE FOLLOWING N1ETROD(S) rn ca i j' ® 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULTS) 4903. WITH AUDIBLE AND VISUAL ALARMS.[23CCR§M ZUNI SECONDARY CONTAINMENT IS: ❑ a.DRY ® b.LIQUID FILLED ❑ c-PRESSURIZED ❑ d.UNDER VACUUM 4903. PANEL MANUFACTURER Veeder-Root 490-7' MODEL#: TLS-350 49o4. LEAK SENSOR MANUFACTURER: Veeder-Root "190'9' MoDEL#(s): VR 302 .!E'[•� X-cS 490-1°. ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WAI..L T NKZS).[23c c §2ew7 PANEL MANUFACTURER: MODEL#: IN-'TANK PROBE MANUFACTURER 450da MODEL#(S): J9at5. LEAK TEST FREQUENCY: ❑ a CONTINUOUS ❑ b.DAILYINIGHTLY ❑ c.WEEKLY 490-16. ❑ d.MONTHLY ❑ e.OTHER(Specify): Oso-Tt. PROGRAMMED TESTS: ❑ a 0.1&P.h. ❑ b.02&P-IL ❑ c.OTHER(Specify): 09 40-1& ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION Im mR§MM.ij 450-20. ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)jnmitlt ul TESTINGPERIOD: ❑ a36HOURS ❑ b.60 HOURS 49022. ® 5.TANK INTEGRITY TESTING PER 123 Mk§2643.1! 450-23. TEST FREQUENCY: ® a ANNUALLY ❑ b.BIENNIALLY ❑ e.OTHER(Specify): 490 50.24. ❑ 99.OTHER(Specify): 49026 V. PIPE MONITORING IS PERFORMED USING THE FOLLOWINGMETHOD(S) ,h"dk I j ® 1.CON'T'INUOUS MONCCORING OF PIPEiPIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE&VISUAI.ALARMS. >o0-2s. l23 R CCSECONDARY CONTAINMENT IS: ® a DRY ❑ b.LI UID FILLED ❑ c.PRESSURIZED ❑ d.UNDER VACUUM 490-z9. § CC Q PANEL MANUFACTURER Veeder-Root 490.30. MODEL#: TLS 350 '"0.31 LEAK SENSOR MANUFACTURER Veeder-Root 49°-32 MODEL#(S): VR 208 490.33. PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(La,TURBINE)SHUTDOWN. ❑ a YES ❑ b.NO 49 m FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ® a YES ❑ b.NO 090.35. ® 2.MECHANICAL LINE LEAK DETECTOR(MLID)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS AND RESTRICTS OR SHUTS OFF 490-36 PRODUCTFLOW WHEN A LEAK IS DETECTED.[23 CCR§26361 MLLD MANUFACTURER(S):VMI 99 ' MODEL#(S): LD 2000 465 38. ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g p.h.LEAK TESTS.In CCR§M361 490'35. ELLD MANUFACTURER(S): 490.d0' MODEL N(S): 490-01 PROGRAMMED IN LINE LEAK TEST: ❑ a MINIMUM MONTHLY 0.2 g.p.h. ❑ b.MINIMUM ANNUAL 0.1 g.p.h. 49042 ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a YES ❑ b.NO a90'43 SLID FAILURE(DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a YES ❑ b.NO 490.44 ❑ 4.PIPE INTEGRITY TFSTING. ---- --�4W45 TESTFREQUENCY: ❑ a ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(Specify) 49p4.,t90-4u ® 5.VISUAL PIPE MONITORING. 490)8 FREQUENCY: ® a DAILY ❑ b.WEEKLY ❑ c.MIN.MONTHLY REACH TIME SYSTEM OPERATED- 490'45 _ •Atbwedf funbrmN fitl '" W HSC 25281) ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA.W CCR§26Np)(3)I 490'50 ❑ 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7IS CONNECTED TO THE TANK SYSTEM. 490651. ❑ 99.OTHER(Specify) IIW33 UPCF UST-D(122007)-114 www.unidm.org