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a a UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN- (Pae 1 of 2 TYPE OF ACTION ® 1.NEW PLAN ❑ 2.CIIANGE OF INFORMATION 490.1 PIAN 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 I I/ BUSINESS NAME(Same as Facility Nemo orDBA) 3 lJ N I�� Kfl MINI MART O P b BUSINESS SITE ADDRESS 103. CITY loa. 257 7 S. P>q7 T�6LSo� F�f}SS � . TRA C II. EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE Testing,preventive maintenance,and calibration of monitoring equipment(e.g.,sensors,probes,line leak detectors,etc.)trust be performed at the frequency specified by the equIpIn t manufacturers'instructions,or annually,.whichever is more frequent.Such work must be_perforrmxl bualified MCI. 23 CCR§2632,2634,2638,2641 EQUIPMENT IS SERVICED ® 1.ANNUALLY [199.OTHER 4W3a MONITORING E Q (Specify): 490.36. III. MONITORING LOCATIONS ❑ 1.NEW SITE PLOT PIAN/MAP SUBMITTED WITH THIS PLAN ® 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED (23 CCR§2632,2634) 4904. IV. TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) `GJ'eck�lll 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) 490-5 WITH AUDIBLE AND VISUAL ALARMS.(23 CCR§2632,26341 SECONDARY CONTAINMENT IS: ® a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURPLED ❑ d.UNDER VACUUM 490-6 PANEI.MANUFACIURER: V E D E iZ - 1R O O T 490.7. MODEI.#: TLS -:3.170 490.g- LEAK SENSOR MANUFACTURER V E D .(Q - ?,00-r 496'9 MODEL#(S): 3 cf 0 -407 490.10 ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).(23 CCR§26431 490-11 PANEL MANUFACTURER: 490"12 MODEL#: 490.13. IN-TANK PROBE MANUFACTURER: 490.14. MODEL#(S): 490-15. LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY 490.16. ❑ d.MONTHLY ❑ e.OTHER(Specify): 490-17. PROGRAMMED TESTS: a.0.1 h. ❑ b.0.2 h. c.OTHER(Specify): 490-Is _ ❑ _B P g.p.h. ❑ ( Pec fY) 49419. ® 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION[z3 CCR§2646.11 D A l I-,y I N V F N TORY F FLS j� a9azo- ® 90-21 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 ccR§264sl TESTING PERIOD: ❑ a.36 HOURS ❑ b.60(TOURS 422. _ _ a9o-u; ❑ 5.TANK INTEGRITY TLSTING PER 123 CCR 12643,11 -- 491123 24. TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY F-1 c.OTHER(Specify): 4904.25. . ❑ 99.OTHER(S 49427.27. ify): 4 90-26 V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) that al'eckal) 19 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE&VISUAL ALARMS. 4,10-28 [23 CCR SECONDARY CONTAINMENT IS: ® a.DRY ❑ b.LIQUID FB.LFD ❑ c.PRESSURU",ED ❑ d.UNDER VACUUM 490-29. 9261 PANEL MANUFACTURER V E C=D C2- Rco T 490.30- MODFI.#: TL.0 - 3-5C 490-31. LEAK SENSOR MANUFACTURER: V E E D EQ - ROOT 490-32 MODEL#(S): 71:74 3$0 - Z O 8 090.33. PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. 0 a.YES ❑ b.NO 490-34, FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. IS a.YES ❑ b.NO 490-31. ---- __ ----- --- _-.-.----.... ---- ....._.. ....- .....----... 2 MECHANICAL LINE LEAK Dli"TF.CTOR(MLLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS AND RESTRICTS OR SHUTS OFF 490- , PRODUCT FLOW WHEN A LEAK IS DETECTE D.123 CCR§26361 MLLD MANUFACTURER(S): 490.37 MODEL#(S): 490.36 ® 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TISTS.[23 cert§26366) /L eyo 0-9 ELLD MANUFACTURER(S): V E E Q EiZ - Roo I 490.40 MODEL#(S): U+S T 490.41. 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 490.43. F.I.I.D FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ❑ b.NO 49°44• _ .....__.� _- _-_..- ---- --- -- - - -- ® 4.PIPE INTEGRITY TESTING. 49045. TEST FREQUENCY: ® 490.46,a.ANNUALLY_ ❑ b.EVERY 3 YEARS ❑ c.OTHER(Specify) 49 490 _ ❑ 5.VISUAL PIPE MONITORING. 49a4e. FREQUENCY: ® a.DAILY ❑ b.WEEKLY ❑ c.MIN.MONTHLY&EACH TIME SYSTEM OPERATED* 490.49. •Allowed OLM- unburied enwpencY-g-eoe_raror fid piping only w HSC§25281.S(b J),.--,,,,_ ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA.Iz3CCR§26Aanl 490-50. - - --...-_..--- - ❑ 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM. 490.51. -----R ---..._.........--PIP ---- - 49452 ❑ 99.OTHER(Specify) 490-53. UPCF UST-D(12/2007)-1/4 www.un(domorg