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SAN JOA--.,*QWN OUNTY ENVIRONMENTAL HEALTH DE TNTENT UNDMILCAOUND gTOleACE TANK a� MOMMUM 't P"N_11A(11112 1 TYPE OP ACTION C3 1.NEW PLAN n 2.CHANCE OF INPOI4MA710N m --�FIZJNI'fPJTLiNL"!§YY� AYF4A a A L (Check one item only) ❑ THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S). FACILITY ID#(Agen y Uae Only) _ e !1 FACILITY NAME FACILITY SITE ADDRESS > (g/, ��d>fi2 �rr�y Moa, CITY .SYdf.L'70.J Mos Ix-� r State law requires that testing,preventive maintenance,and calibration of monitoring equipment(e.g.,sensms,probes,-line leak detectors,etc.)be performed in Moa accordance with the equipment manulbcuuers'instmctions,or annually/,whichever is more.frequent. Such work must be performed by qualified personnel. MONITORING EQUIPMENT IS SERVICED 1{,f ).ANNUALLY ❑ 99.OTHER(Specify):_ M07 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, Zine leak deteetw,monitoring systm control pv 1,etc.). If you already have a diagram(e g.,current UST Monitoring Site Plan from a Monitoring System Certification form Hamrdous Materials Business Plan etc. which shows all«wired information include it with this Ian. CORING IS PERFORMED USING THE FOLLOWING METHOD(S):(Check all that apply) M1J ONTINUOUS ELECTRONIC MONITORII�F TANK ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) SBOONDAPY CONTAIPNMENT IS: a.DRY ❑ b.LIQUID FILLED ❑.c.UNDER PRESSURE ❑ d.UNDER VACUUM Mit. PANEL MANUFACTURER: , lL QLO M" MODEL#: Mu. LEAK SENSOR MANUFACTURER I L It A-A W Mta. MODEL#(S). `I 1611 1 o - a Mts. ❑ 2.AUTOMATIC.TANK GAUGING(ATO)SYSTEM USED TO MONITOR SINGLE WAIL TANK($j PANEL MANUFACTURER: ana, MODEL#: mit IN-TANK PROBE MANUFACIURER: Mls MODEL#(S): M19 LEAK TEST FREQUENCY: ❑ a..CONTINUOUS ❑ b.DAILY/NIGHTLY [3 c.WEEKLY ]VC20. ❑..d.MONTHLY ❑.e.OTHER(Specify): W1' PROGRAMMED TESTS: ❑.a 0.1.g.p.h. ❑.b..0.2 g.p.h. ❑ c.OTHER(Specify): Mu mm ❑ 3.INVENTORY RECONCILIATION ❑ a MANUAL PER 23 CCR§2646 ❑ b..STATISTICAL PER 23 CCR§2646.1 ' ❑ 4.WEEKLY MANUAL TANK GAUGING(MM)PER 23 CCR§2645 TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS aM ❑ 5.INTEGRITY TESTING PER 23 CCR 12643.1 TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTTIER(Specify): ❑ 6.VISUAL MONITORING DONE: ❑ a DAILY ❑ b,WEEKLY(R"-,-es�cy.rOm.eO ❑ 99.OTHER(Specify) MN- : T W6, 19 W,MpabWarollm, Now MO, 170RTNG IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) FDO. I.CONTINUOUS ELECTRONIC MONTTORING F PIPING SUMP(SYMMCH(ES)AND OTHER SECONDARY CONTAINMENT SECONDARY CONTAINMENT IS//'' aDRY ❑. b.LIQUID FILLED [3 a UNDER PRESSURE [Id.UNDER VACUUM Mal. PANEL MANUFACTURER: . ; L6n¢w am MODEL#: E{ Mil, LEAK SENSOR MANUFACTURER: r 7 MX MODEL#(S): -, � ZO fi nua. WILL A PIPING LEAK AT-ARM TRIGGER AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN? p�ap,y a.YES G b.NO WILL FAILURE/DISCONNECTION OF THEua MONITORING SYSTEM TRIGGER AUTOMATIC.PUMP SHUTDOWN? aYES ❑ b.NO AO7 ( .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(# V&j r �O f le p !*rjce dOB MODEL#(S). Z V d X( wf art9. ELECTRONIC LINE LEAK DETECTOR( ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS a ELLDMANUFACCURER: SS M00 MODEL# a Mat. PROGRAMMED LINE INTEGRITY TESTS. [--) a MINIMUM MONTHLY 0.2 g.p.h. M b.MINIMUM,ANNUAL 0.1 g.p.h. Ma WILL ELLD DETECTION OF A PIPING LEAK TRIGGER AUTOMATIC PUMP SHUTDOWN? ❑ n.YES ❑ b.NO rias. WILL E.LD FAILURE/DISCONNECTION TRIGGER AUTOMATIC PUMP SHUTDOWN? ❑ e,YES ❑ b.NO W4. ❑ 4.INTEGRITY TESTING `.,,� TEST FREQUENCY: ANNUALLY [3b.EVERY 3 YEARS. El C.OTHER(Specify) Mas- ❑ 5.VISUAL MONITORING DONE: a.DAB.Y ❑ b.WEEKLY* ❑ C.MIN.MONTHLY&EACH TIME SYSTEM OPERATED-- Mn. •Rrnur'almy9p 41 •".Alb..ed Por rtaitibmaof mEueied emeranry gmeraw ad gP�n6aM'°er H9C 43336i.e(bK3) ❑ 6.PIPING IS SUCTION PIPING MEETING ALL REQUIREMENTS FOR EXEMPTION FROM MONITORING PER 23 CCR§2636(aR3) ❑ 7.NO PRODUCT OR REMOTE FILL PIPING IS CONNECTED TO THE UST(s) ❑ 99.OTHER(Speci(v) Mas. SICEHD-d(07/03).1/4 07/23/03