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UNIFIED PROGRAM CONSOLIDATED FORM
<br /> UNDERGROL)ND STORAGE TANK
<br /> MONITORING PLAN- (Page I of 2
<br /> TYPE OF ACTION '❑ 1.NEW PLAN ❑ 2.CHANGE OF INFORMATION 490-1.
<br /> PLAN TYPE `fip 1,MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. 490-2-
<br /> (Check one item only) ❑ 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S):
<br /> I. FACILITY INFORMATION
<br /> FACILITY ID#(Agency Use Unty) I ITTTI _1 I I I I I I
<br /> BUSINESS NAM 1e as Faclllly Name or DBA) 3.
<br /> S
<br /> BUSINESS SITE ADDRESS los. CITY 104.
<br /> yM 14e L o fo
<br /> II. EQUIP NT TESTING AND PREVENTIVr MAINTENANCE
<br /> Testing,preventive maintenance,and calibration of monitoring equipment(e.g„sensors,probes,line leak detectors,etc.)must be performed at the frequency specified
<br /> ,by - - - ---- - --------- -- -- lied personnel-[2CC §2632,264,2658,2insEuo � S- -._..._..-- - 601)
<br /> 496-30,
<br /> MONITORING EQUIPMENT IS SERVICED 1A 1.ANNUALLY ❑ 99.OTHER(Specify): 4900 3b.
<br /> III. MONITORING LOCATIONS
<br /> ❑ 1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN [L 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED P CCR§2632,2634) 690-6.
<br /> IV. TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) (Checkall
<br /> that 1
<br /> 1,CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) --s-
<br /> WITH AUDIBLE AND VISUAL ALARMS.[23 CCR 02632,2624)
<br /> SECONDARY CONTAINMENT IS: N a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED L7 d.UNDER VACUUM 490.6.
<br /> PANEL MANUFACTURER V,Ogn /4 . Q,,,y T qO'2' MODEL#. S `�Sz7 49a-9.
<br /> LEAK SENSOR MANUFACTURER: \/0e2�JrL- rZce+.. f 490.9. -MODEL#(S): a 490-10,
<br /> ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).[23 CCK 62643] 490-11,
<br /> PANEL MANUFACTURER: 490-12, MODEL#: 490-13.
<br /> IN-TANK PROBE MANUFACTURER: 490 is. MODEL#(S)r 490.15.
<br /> LEAK TEST FREQUENCY: ❑ a_CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY a90-16.
<br /> ❑ d.MONTHLY ❑ e.OTHER(Specify): 490.17.
<br /> PROGRAMMED TESTS: ❑ it 0.1 _h ❑ b.0.2 c.OTHER 490-I 6,
<br /> S Ci _ ago-19___
<br /> ---- ----... ------_._.
<br /> ❑ 3.MONTHLY STATIST[CAL INVENTORY RECONCILIATION[23 CCR 12646.il49aaa.
<br /> _....._..._............._._..__..,.. ........_.___.._......----.....-..._,,._._, ..,_ .,. ,,._..,,.,.._._..,.,.,,.,, .,,..........,., ,.....-_.��-- ._._..----._.....-------- --._._.___--_.-._._.. --._..._.._._..-..- ..._..------ ---
<br /> 490.21.
<br /> ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)[23 CCR 12643] TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS 490-22.
<br /> ❑ 5.TANK INTEGRITY TESTING PER[23 CCR 62643.q 49423.
<br /> TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): age 20,.
<br /> _.._._._.._.._......_._...-.......--...._._._._._....._._.._....... --_._.__.... ..._.._.__.._.___. .-- -
<br /> ❑ 99.OTHER(Specify): 490-27.
<br /> V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING.METHOD(S) Mal apply)
<br /> C'''all
<br /> 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE&VISUAL ALARMS. 4911.24.
<br /> 123 CCR SECONDARY CONTAINMENT IS: I a,DRV ❑ b.LIQUID FILLED El c-PRESSURIZED [__1d.UNDER VACUUM 490-29.
<br /> 62636) '?
<br /> PANEL MANIUFACCURER: y��D�Z- Zoo/_ _ 490-30- MODEL#; S 490,3:.
<br /> LEAK SENSOR MANUFACTURER: y+Sdoba*_- lZnv f 490-32. MODEL#(S): ��� 49433.
<br /> PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN, ❑ a.YES ❑ b.NO 490.34.
<br /> FAILUREJDISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ❑ b.NO 4""
<br /> ❑ 2.MECHANICAL LINE LEAK DETECTOR(MLLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS AND RESTRICTS OR SHUTS OFF 49x-36•
<br /> PRODUCT FLOW WHEN A LEAK IS DETECTED.(23 CrR12636)
<br /> MLLD hiANUFACTURER(S): 690x'' MODEL: 49045.
<br /> 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS.[23 CCR626361 a90,99'
<br /> ELLD MANUFACTURER(S):'V&a b6A_ ZQt'f 490-40. MODEL#(S): �? Y 49041.
<br /> PROGRAMMED INN LINE LEAN{TEST: ❑ a.MINIMUM MONTHLY 0.2 g.p_h. ❑ b.MINIMUM ANNUAL 0.1 g.p.h. 490-42.
<br /> ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. '5 a.YES ❑ b,NO 400-41-
<br /> ELLD FAILUREIDISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. 5L a.YES ❑ b.NO 49144'
<br /> ❑ 4.PIPE INTEGRITY TESTING, 49045.
<br /> TEST FRS UENCY: ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(Specify) 690-'6.
<br /> ❑ 5.VISUAL PIPE MONITORING. 490-48,
<br /> FREQUENCY: ❑ a.DAILY ❑ b.WEEKLY ❑ c.MIN.MONTHLY&EACH TIME SYSTEM OPERATED. 490 d9.
<br /> moalfor(gL1K9mudcukm-__FHy-garcnlor t_i!Plr4uanllxmLl
<br /> ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA.123 CCR*2636(XX3)] 45450.
<br /> El7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM. 49451.
<br /> E] 99.OTHER(5 eci ) 490 R
<br /> 490,33.
<br /> UPCF UST-D(1212007)-1/4 www.unidocs.org
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