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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN- Pae 1 of 2) TYPE OF ACTION ❑1.NEW PLAN 2.CHANGE OF INFORMATION 490-1 PLAN TYPE fl1.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) BUSINESS NAME(Same as FACILITY NAME) 3. r BUSINESS SITE ADDRESS(2; ( S r _ 103. CITY Lnf� 104. 1 II.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 6L2342638,j&UL--- MONITORING EQUIPMENT IS SERVICED 1-ANNUALLY El99.OTHER(Specify): 490:3b III.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 USING THE FOLLOWING METHOD(S): 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT 490-5 VAULT(S)WITH AUDIBLE AND VISUAL LARMS. (23 CCR§2632,2634) ----SECONDARY CONTAINMENT IS:- a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED ❑d.UNDER VACUUM 490-6 PANEL c 490-0. MODEL# >~---- ----490-s ---- LEAK SENSOR MANUFACTURER: Lk 490-9. MODEL#(S): ago`-io ❑ 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: 490-14. MODEL##(S): 490-15 - --- ------------------ LEAK TEST FREQUENCY: ❑ a.CONTINUOUS - - - Q ❑ 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.OTHERS ci 490-18 g p g p ( Pe fy): 490-19 ❑ 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 ❑ b.60 HOURS 490-21 490-22 ❑ 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 490-23 TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): 490-24 490-25 ❑99.OTHER (Specify): 490-26 490-n 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 490-28 ISUAL ALARMS. (23 CCR§2636) SECONDARY CONTAINMENT IS.:*.DRY ❑b.LIQUID FILLED ❑c.PRESSURIZED ❑d.UNDER VACUUM 490-29 - ---- - ---- PANEL MANUFACTURER: 49030 � MODEL#--------1 ---- ------ 490-31 --_ tir Gy O C7+ __ c LEAK SENSOR MANUFACTURER: - -�1 -- - _-- 490_32 -MODEL#(S)_______-- O 490.33 ------EAK SENSOR MA----------- --------- PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. 1z a.YES ❑b.NO 490-34 FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. Ia.YES ❑K NO 490-35 2.MECHANICAL LINE LEAK DETECTOR(MLLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TEST9 AND RESTRICTS OR SHUTS OFF _- PRODUCT FLOW WHEN A LEAK IS DETECTED S23 CCR2636 -_ 490-36 MLLD MANUFACTURER(S):� 490-37 MODEL#(S - 49038 ❑ 3.ELECTRONIC_LINE LEAK DETECTOR(ELLE()THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS (23 CCR§A36) 490-39 - ELLD MANUFACTURER(S) ---- ---- 490-40. MODEL#(S): --------------- 49°41 PROGRAMMED IN LINE LEAK TEST: ❑ 1.MINIMUM MONTHLY 0.2 g.p.h. ❑ 2.MINIMUM ANNUAL 0.1 g.p.h. 490.42 ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 490-43 ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 49044 ❑ 4.PIPE INTEGRITY TESTING 490.45 TEST FREQUENCY ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(Specify) 490-46 490-07 ❑ 5.VISUAL PIPE MONITORING. 49048 FREQUENCY ❑ a.DAILY ❑ b.WEEKLY ❑C.MIN.MONTHLY&EACH TIME SYSTEM OPERATED' 49049 •Allowed for monitoring of unburied em-ency generator fuel piping only per HSC 25281.5 3 ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR§2636(ax3)1• 490.50 ❑ 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM 490-51 ❑ 99.OTHER(Specify) 49052 490-53 UPCF UST-D(12/2007)1/4