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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 ® 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 Facilitv Name or DBA) 3 7 -Eleven # 19976 BUSINESS SITE ADDRESS 1399 N. Main Street 103. CITY Manteca Bw 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. Such work must be performed by qualified personnel. [23 CCR §2632, 2634, 2638, 26411 490-3& MONITORING EQUIPMENT IS SERVICED ® 1. ANNUALLY ❑ 99. 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, 26341 4X14. IV. TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD S)1 (Check a" METHOD(S) that apply) ® L 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: -1 a. DRY X b. LIQUID FILLED Elc. PRESSURIZED El d- UNDER VACUUM 490-6. PANEL MANUFACTURER: Veeder-Root 490-7. MODEL #: TLS -350 490-8. LEAK SENSOR MANUFACTURER: Veeder-Root 490-9. MODEL #(S): 794380-302 490-10' ❑ 2. AUTOMATIC TANK GAUGING (ATG) SYSTEM USED TO MONITOR SINGLE WALL TANK(S). [23 CCR §26431 °gall. PANEL MANUFACTURER: 490.11 MODEL #: 490-13. IN -TANK PROBE MANUFACTURER: 490-14. MODEL #(S): 490-15. LEAK TEST FREQUENCY: ❑ a. CONTINUOUS ❑ b. DAILY/NIGHTLY ❑ c. WEEKLY 49046. ❑ d. MONTHLY ❑ e. OTHER (Specify): 490-17. 8. PROGRAMMED TESTS: ❑ a. 0.1 h. ❑ b. 0.2 h. ❑ c. OTHERS ci 490-1.. g.p.h. g.p.h. (Specify): _°vii -iv<_..._.._ ❑ 3. MONTHLY STATISTICAL INVENTORY RECONCILIATION [23 CCR §2646.11 490-20 ❑ 4. WEEKLY MANUAL TANK GAUGING (MTG) [23 CCR §26451 TESTING PERIOD: ❑ a. 36 HOURS ❑ b. 60 HOURS4� a 21 ❑ 5. TANK INTEGRITY TESTING PER 123 CCR §2643.11 490-23. 490-24. TEST FREQUENCY: ❑ a. ANNUALLY ❑ b. BIENNIALLY ❑ c. OTHER (Specify) 490-25.__ _...--- 490-26. ® 99. OTHER (Specify): Overfill protection -Flapper 4X1-27. V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) (h heack "u ® 1. CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S) AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE & VISUAL ALARMS. 49x28. [23 C SECONDARY CONTAINMENT IS: ® a. DRY ❑ b. LIQUID FILLED ❑ c. PRESSURIZED ❑§2636 d. UNDER VACUUM 490-29. PANEL MANUFACTURER: Veeder-Root 490.30. MODEL #: TLS -350 ago -31. LEAK SENSOR MANUFACTURER: Veeder-Root 490-32. MODEL #(S): 794380-208 490-33. PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP (i.e., TURBINE) SHUTDOWN. ® a. YES ❑ b. NO 490-34. FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ® a. YES ❑ b. NO 490-3'- X 2. MECHANICAL LINE LEAK DETECTOR (MLLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS AND RESTRICTS OR SHUTS OFF 490-36. PRODUCT FLOW WHEN A LEAK IS DETECTED. [23 CCR§26361 MLLDMANUFACTURER(S): V8 orless/ F.E. Petro 490-37. MODEL#(s): LD2000 / STD -MLD 490-38. ❑ 3. ELECTRONIC LINE LEAK DETECTOR (ELLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS. [23 CCR§26361 490-39, ELLD MANUFACTURER(S): 49"0 MODEL #(S): 490.41. PROGRAMMED IN LINE LEAK TEST: ❑ a. MINIMUM MONTHLY 0.2 g.p.h. ❑ b. MINIMUM ANNUAL 0.1 g.p.h. 4904Z ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ & YES ❑ b. NO 490.43. ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a. YES ❑ K NO 4%44 ® 4. PIPE INTEGRITY TESTING. ago -as. TEST FREQUENCY: ❑ a. ANNUALLY C1 b. EVERY 3 YEARS ® c. OTHER (Specifv) SB989 every 36 mo. 4�6 _ ❑ 5. VISUAL PIPE MONITORING. 490-48. FREQUENCY: ❑ a. DAILY ❑ b. WEEKLY ❑ C. MIN. MONTHLY & EACH TIME SYSTEM OPERATED* 49049. • Allowed for monitoring of unburied emergency generator fuel ming only per HSC §2528 1.5(6)(3) _ ❑ 6. SUCTION PIPING MEETS EXEMPTION CRITERIA. [23 CCR §2636(aX3)1 49090-50. ❑ 7. NO REGULATED PIPING PER HEALTH AND SAFETY CODE, DIVISION 20, CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM. 490-51. 490-52 ❑ 99. OTHER (Specify) 490-53. UPCF UST -D (1212007) - 1/4 www.unidocs.org