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UMWEED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN-(Page 1 of 2 TYPE OF ACTION El 1.NEW PLAN El 2.CHANGE OF INFORMATION ago-1. PLAN 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) BUSINESS NAME(Same as Facility Name or DBA) 3. G btu iZ d'''►' 1'1')1 R j A BVyS SS SITE ADDRESS 103 C 104. U. EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE Testing,preventive maintenance,and calibration of monitoring equipment(e.&,sensors,probes,line leak detectors,etc.)must be performed at the frequency specified the e u�ment manufacturers'instructions,or annually,whichever is more frequent.Such work must be performed by qualified personnel_[23 CCR§2632,2634,2638,26411 490-3s MONITORING EQUIPMENT IS SERVICED ANNUALLY ❑ 99.OTHER(Specify): 490-3b. M. MONITORING LOCATIONS ❑ 1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN )d 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED [23 CCR§2632,26341 49o1. IV. TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) that heck apply) 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: 14 a.DRY Elb.LIQUID FILLED ❑ c.PRESSURIZED ❑ d.UNDER VACUUM 490-6 PANEL MANUFACTURER: V 1sx-1 r-y- Q.,T- 490-7. MODEL#: 'CL-16 drD 49". LEAK SENSOR MANUFACTURER: �� '��(L P-10!0+ 490-9" MODEL#(S):/ •tj! 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. 490-18. _ _PROGRAMMED TESTS:_ ❑ a.0_1_g.p.h. ❑ b.0.2 gp.h. C] ER c.OTH (Specify): _ 490-19. [Ell 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION[23 ccR§2646.13 _- 490-20. ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)[23 ccR§26451 TESTING PERIOD: ❑ a.36 HOURS Elb.60 HOURS a9az1- 49412. - ----- --------- 490-23. ❑ 5.TANK INTEGRITY TESTING PER 123 CCR§2643.11 49414. TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): _ 490-25. -- -------- - - - -- 490-26. ❑ 99.OTHER(Specify): 490-27. eck all (Ch V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) 'Clapply) 1.CONTINUOUS MONITORING OF PIPEIPIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE&VISUAL ALARMS. 490-28- [23 CCR SECONDARY CONTAINMENT IS: JO a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED ❑ d.UNDER VACUUM 490-29- §26361 PANEL MANUFACTURER YC�'1 � 12M4 490-30. MODEL#: TLS Sb 1 490-31. LEAK SENSOR MANUFACTURER: \j I 490-31 MODEL#(S):, �) �� -33 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. gj a.YES LTb.NO 490-34. FAILUR&DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ® a.YES ❑ b.NO 490-35. 2.MECHANICAL LINE LEAK DETECTOR(MLLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS AND RESTRICTS OR SHUTS OFF 4s0-36. PRODUCT FLOW WHEN A LEAK IS DETECTED.[23 CCR§26361 490-37. 490-39.#S L. 000 a90-3e. MLLD MANUFACTURER(S):V/}�,12.IES{ MO_-"---(-)- ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TSTS.[23 ccR§26361 490 39. E ELLD MANUFACTURER(S): 49040 MODEL#(S): 49041. PROGRAMMED IN LINE LEAK TEST: ❑ a.MINIMUM MONTHLY 0.2&p-h. ❑ b.MINIMUM ANNUAL 0.1&p.h. 490-41 ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ❑ b.NO 49043. ELLD FAILUREIDISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. _ ❑ a.YES ❑ b.NO 49044- 49D45 ❑ 4.PIPE INTEGRITY TESTING. 490-46. _ TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(Specify) 49047. 490-48. 5.VISUAL PIPE MONITORING. FREQUENCY: a DAILY ❑ b.WEEKLY ❑ c.MIN.MONTHLY&EACH TIME SYSTEM OPERATED' 490-49. /� •Nbwed for ImniEotmS of unburiedemery R®eaaro�fud_P�°�a,3u HSC 42szat.s(b)(3) -" ---- 490.80. ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA.[23 CCR§2636(a)(3)1 ❑ 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM._ 49481. - -- --------- -- ---- -490-52. ❑ 99.OTHER(Specify) 490-53. UPCF UST-11(12/2007)-1/4 www.unidocs.org