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1 � 16-Lt=�10 07: 15A FROM: T0:1209468333 r. 1 TiV; (7,9/ ,1677_ l' ez UNIFIED PROGRAM CONSOLIDATED FORM - .. UNDERGROUND STORAGE TANK MONITORING PLAN- Pa c I of TYPE OF ACTION ❑ I.NEW PLAN 2.CHANGE OF INFORMATION 490-1 PLAN TYPE I MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY .': 490.2 Check one item only) ❑ 2.THIS PLAN COVERS ONLY TME FOLLOWING UST SYSTEM(S) 1. FACILITY INFORMATION _ FACILITY ID#(Agency Use Only) BUSINESS NAME(Same as FACILITY NAME) _ J BUSINESS SITE ADDRESS 01Z 103 CITY 104. f II. EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE Testing,preventive maintenance,and calibration of monitoring equipment(c-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§2632,2634,2638,264 1 MONITORING EQUIPMENT IS SERVICED 1.ANNUALLY El 99 OTHER(Specify): 4490_3b III. MONITORING LOCATIONS ❑1.NEW SITE PLOT PLAN/MAP SURMTTTED WITH THIS PLAN. W 2.SITE PLOT PLAN/MAP PRF,VIOUSLV SUBMITTED- (23 CCA§2632, 2634)49o-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 VAULTS)WITII AUDIBLE AND VISUAL ALARMS. (23 CCR§2632,2634) SECONDARY CONTAINMENT IS: M a DRY ❑ b.LIQUID FILLED [:1c PRESSURIZED C]d.UNDER VACUUM 49x6 - 490-1 --v--------- 690.8 PANEL MANUFACTURER - b b MODEL# T t_ 1-� _ 490.9 MODEL#{S)' D 490-[0LEAK SENSOR MANUFACTURER L ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTFM USED TO MONITOR SINGLE WALL TANK(S),(23 CCR§2643) 49011 490-12 MODEL fl: °W13 PANEL MANUFACTURER: _ - a90.14 MODEL#(S). 490.15 IN-TANK PROBE MANUFACTURER _ _ ----- --- - --- b.DAILY/NIGHTLY ❑ c.WEEKLY 490.16 LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ aoo-1•r ❑ d.MONTHLY --------E]--e. (Sp�t�)-- - ------- -- --------.... PROGRAMMED TESTS: C3 a.0.1 g p.h. El b. (Specify)-b.0.2 g p.h. ❑ c Ol-HS 1 490-19 - 490-20 ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): ago-it ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§2645). TESTING PERIOD. Ela.36 HOURS ❑ b 60 HOURS 490.22 490-Z3 El 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 4490.24 TEST FREQUENCY: ❑ a ANNUALLY ❑ b.BIENNTALLY ❑ c-OTHER(Specify): 490.25 490.26 ❑99 OTHER (Specify): 490-27 V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) I.CONTINUOUS MONrrORING OF PIPE!PIPING SUMPS)AND OTIIER SECONDARY CONTAINMENT WITH AUDIBLE AND ago z9 SUAL ALARMS. (23 CCR§2636) 49049 SECONDARY CONTAINMENT IS�a.DRY ❑b.LIQUID FILLED ❑c.PRESSURIZED ❑d.UNDER VACUUM v_ 1----- .-_----- -_- 490-31 690J0 PANEL MANUFACTURER Lr ago-3z t MODEL#: � 490-33 ? _/` ---� 1 LEAK SENSOK MANUFACTURER ( fujQJl t MODEL#(S) a,✓.� ____- n-YES ❑b.NO 490-34 PIPING LEAK ALARM TRIGGERS Al1TOMATIC PUMP(i.e..TURBINE)SHUTDOWN. 490.35 FAILUREIDISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. t$a.YES ❑b.NO 2.MECHANICAL LINE LEAK DETECTOR(MLLD)THAT ROUTINELY PERFORMS 3.4 g p.h.LEAK TESTS AND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK IS DETECTED 23 CCR 2636 --- _-- _ 490--36 � ---- 490- 490.37 J8 MLLD MANUFACTURER(S): MODEL#(S): - 2,O O(3 ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g-p.h.LEAK TESTS (23 CCR§2636) 494-J9 49040 MODEL#(S) ELLD MANUFACTURER(S) FROG RAMMED IN LINE LEAK TEST: ❑ 1 MINIMUM MONTHLY 0 2 g-p.h ❑ 2.MINIMUM ANNUAL 0.1 gp.h. a9o�a2 a.YES ❑b.NO 490-43ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. C149044 ELLD FAILURE(DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN- ❑a.YES ❑b NO 4.PIPE INTEGRITY TESTING 49045 490.46 490.47 TEST FREQUENCY [I a.ANNUALLY C1 b.EVERY 3 YEARS ❑ c OTHERS cif a00.4A 5.VISUAL PIPE MRING. 490..49 FREQUENCY a.DAILY ❑ b WEEKLY El c.MIN-MONTIiLY&EACH TIME SYSTEM OPERATED• •Atl0v ed for m0mtu n of mbaned mm9encY Awff='fuel pjpmgonjJISC§25291 5M3) ❑ 6.SUCTION PIPING MEET'S EXEMPTION CRITERIA 123 CCR§2636(0)(3)). ago so 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7[S CONNECTED TO THE TANK SYSTEM 490.51 490-52 ❑ 99.OTHER ago 53 (Specify)