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r� UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN - (Page 1 of 2) TYPE OF ACTION ❑ I. NEW PLAN ® 2. CHANGE OF INFORMATION 490-1. PLAN TYPE ® 1. MONITORING 1S 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 M # (Agency Use Only) t. BUSINESS NAME (Same as Facility Name or DBA) 3. 7 -Eleven #19976 BUSINESS SITE ADDRESS 103. 1399 N. Main CITY Manteca 104. 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, which_e_ver is more frequent. Such work must be performed by qualified personnel. (3 CCR 12632, 2634. 2638. 264 1) MONITORING EQUIPMENT IS SERVICED ® 1. ANNUALLY C199.OTHER (Specify): 4990-3b. III. MONITORING LOCATIONS ❑ 1. NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN ® 2. SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED 123 CCR 12632.2634) 490-4. IV. TANK MONITORING IS PERFORMED USING THE FOLLOWING METHODS) �teackall 1. CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR (INTERSTITIAL) SPACE(S) OR SECONDARY CONTAINMENT VAULT(S) 490-5 WITH AUDIBLE AND VISUAL ALARMS. [23 CCR 1'-632.26341 SECONDARY CONTAINMENT IS: ® a. DRY ❑ b. LIQUID FILLED ❑ c. PRESSURIZED ❑ d UNDER VACUUM 490.6. PANEL MANUFACTURER: VeederROOt 4907. MODEL #: TLS -350 490-8. LEAK SENSOR MANUFACTURER: VeederROOt 490-9- MODEL #(S): 794380-302 490-10. 2. AUTOMATIC TANK GAUGING (ATG) SYSTEM USED TO MONITOR SINGLE WALL TANK(S). [3 CCR 126431 411 PANEL MANUFACTURER: 490-12' MODEL #: 490-13. IN -TANK PROBE MANUFACTURER: 490-14. MODEL #(S): 490-13' LEAK TEST FREQUENCY: ❑ a. CONTINUOUS ❑ b. DAILY/NIGHTLY ❑ c. WEEKLY 490-16. ❑ d. MONTHLY ❑ e. OTHER (Specify): 49047. PROGRAMMED TESTS:_ a. 0.1 h. b. 0.2 h. c. OTHER (Specify): ❑ g•P• ❑ g•P• ( P dY)� 490-t9._ _4-18' _ _❑ ❑ 3. MONTHLY STATISTICAL INVENTORY RECONCILIATION [3 CCR 12646.1] 490-20. ❑ 4. WEEKLY MANUAL TANK GAUGING (MTG)123 cCR 126451 TESTING PERIOD: ❑ a. 36 HOURS [Ib. 60 HOURS 490-21` 490-2?. ❑ 5. TANK INTEGRITY TESTING PER [23 CCR 12643.11 490.23. 490.24. TEST FREQUENCY: ❑ a. ANNUALLY ❑ b. BIENNIALLY C] c. OTHER (Specify): 490-23, - --490-26... ❑ 99. OTHER (Specify): 490-22. V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S)thatack all ® 1. CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S) AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE & VISUAL ALARMS. 490-28. 11'2' CCR SECONDARY CONTAINMENT IS: ® a. DRY ❑ b. LIQUID FILLED Elc. PRESSURIZED ❑ d. UNDER VACUUM 4W29• PANEL MANUFACTURER:VeederROOt 490.30' MODEL#: TLS -350 49x31. LEAK SENSOR MANUFACTURER: VeederROOt 490-32. MODEL #(S): 794380-208 490-33. PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP (i.e., TURBINE) SHUTDOWN. ® a. YES ❑ b. NO 434• FAILUREIDISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ® a. YES ❑ b. NO 490-11. 2. MECHANICAL LINE LEAK DETECTOR (MLLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS AND RESTRICTS OR SHUTS OFF 49036. PRODUCT FLOW WHEN A LEAK IS DETECTED. 123 CCR§26361 MLLD MANUFACTURER(S): Vaporless 490.37. MODEL#(S): LD2000 490-38. ❑ 3. ELECTRONIC LINE LEAK DETECTOR (ELLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS. [23 CcR126361 490-39. ELLD MANUFACTURER(S): 490-40• 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. 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. ---J---- ---- 490-45. 49046. TEST FREQUENCY; ® a. ANNUALLY ❑ b. EVERY 3 YEARS ❑ c. OTHER (Specify) 490-47. ❑ 5. VISUAL PIPE MONITORING. 490-48. FREQUENCY: ❑ a. DAILY ❑ b. WEEKLY ❑ c. MIN. MONTHLY & EACH TIME SYSTEM OPERATED* 490-49. - Allowed for monitoring of unburied emergency generaor fuel piping onlyper HSC §25281.5(b)(3) ❑ 6. SUCTION PIPING MEEi'S EXEMPTION CRITERIA. [23 CCR 12636(ax3)] 49050. ❑ 7. NO REGULATED PIPING PER HEALTH AND SAFETY CODE, DIVISION 20, CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM. 49051. ❑ 99. OTHER (Specify) - 4953 490.53. UPCF UST -D (12/2007) -1/3 www.unido4s.org