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kll� UNDERGROL_ ..) STORAGE TANK MON, _ ORING `�. For use by Unidocs Member Agencies or where approved by your Local Jurisdiction Authority Cited: Title 23 CCR, Sections 2632(d)(1), 2634(d)(2), and 2641(h) S� � -UU0 TYPE OF ACTION ❑ 1. NEW PLAN ® 2. CHANGE OF INFORMATION ENV1R0f11Xv1j' H 01. PLAN TYPE ® MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. PERNIJGERVIC0 J Moe. (Check one item only) ❑ THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): I. FACILITY INFORMATION FACILITY ID # (Agency Use Only) - FACILITY NAME 7 -Eleven #19976 M03. FACILITY SITE ADDRESS 1399 N. Main Street M04. CITY Manteca M05. II. EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE State law requires that testing, preventive maintenance, and calibration of monitoring equipment (e.g., sensors, probes, line leak detectors, etc.) be performed in M06. accordance with the equipment manufacturers' instructions, or annually, whichever is more frequent. Such work must be performed by qualified personnel. MONITORING EQUIPMENT IS SERVICED ® 1. ANNUALLY ❑ 99. OTHER (Specify): Mol' III. MONITORING LOCATIONS This monitoring plan must include a Site Plan showing the general tank and piping layouts and the locations where monitoring is performed (i.e., location of each sensor, line leak detector, monitoring system control panel, etc.). If you already have a diagram (e.g., current UST Monitoring Site Plan from a Monitoring System Certification form, Hazardous Materials Business Plan map, etc.) which shows all required information, include it with this plan. IV. TANK MONITORING MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): (Check all that apply) Mao. ® 1. CONTINUOUS ELECTRONIC MONITORING OF TANK ANNULAR (INTERSTITIAL) SPACE(S) OR SECONDARY CONTAINMENT VAULT(S) SECONDARY CONTAINMENT IS: ❑ a. DRY ® b. LIQUID FILLED ❑ c. UNDER PRESSURE ❑ d. UNDER VACUUM M" - PANEL MANUFACTURER: VeederRoot M12. MODEL#: TLS350 M13. LEAK SENSOR MANUFACTURER: VeeerROot M14. MODEL #(S): 794380-302 MI5. ❑ 2. AUTOMATIC TANK GAUGING (ATG) SYSTEM USED TO MONITOR SINGLE WALL TANK(S) PANEL MANUFACTURER: MI6. MODEL M M17. IN -TANK PROBE MANUFACTURER: M18. MODEL #(S): M19. LEAK TEST FREQUENCY: ❑ a. CONTINUOUS ❑ b. DAIL.Y/NIGHTLY ❑ c. WEEKLY M20. ❑ d. MONTHLY ❑ e. OTHER (Specify): M21. PROGRAMMED TESTS: ❑ a. 0.1 h. ❑ b. 0.2 h. ❑ c. OTHER (Specify): M22. g•P• g•P• ( P fY)� M23, ❑ 3. INVENTORY RECONCILIATION ❑ a. MANUAL PER 23 CCR §2646 ❑ b. STATISTICAL PER 23 CCR §2646.1 M24 ❑ 4. WEEKLY MANUAL TANK GAUGING (MTG) PER 23 CCR §2645 TESTING PERIOD: ❑ a. 36 HOURS ❑ b. 60 HOURS M25. ❑ 5. INTEGRITY TESTING PER 23 CCR §2643.1 TEST FREQUENCY: ❑ a. ANNUALLY ❑ b. BIENNIALLY ❑ c. OTHER (Specify): M26. M27. ❑ 6.VISUAL MONITORING DONE: ❑ a. DAILY ❑ b. WEEKLY (Requires agency approval) ❑ 99. OTHER (Specify): Meg. V. PIPE MONITORING MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply) Mao. ® 1. CONTINUOUS ELECTRONIC MONITORING OF PIPING SUMP(S)/TRENCH(ES) AND OTHER SECONDARY CONTAINMENT SECONDARY CONTAINMENT IS: ® a. DRY ❑ b. LIQUID FILLED ❑ c. UNDER PRESSURE ❑ d. UNDER VACUUM M31' PANEL MANUFACTURER: VeederRoot M32. MODEL#: TLS350 M33. LEAK SENSOR MANUFACTURER: VeederRoot M34. MODEL #(S): 794380-208 M35. WILL A PIPING LEAK ALARM TRIGGER AUTOMATIC PUMP (i.e., TURBINE) SHUTDOWN? ® a. YES ❑ b. NO M36. WILL FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? ® a. YES ❑ b. NO M37- 0 2. MECHANICAL LINE LEAK DETECTOR (MLLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS AND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK IS DETECTED MLLDMANUFACTURER(s): VaDroleSS & Redjacket M38. MODEL #(s): LD2000 & FX1V M39. ❑ 3. ELECTRONIC LINE LEAK DETECTOR (ELLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS ELLD MANUFACTURER: Mao. MODEL #: M41. PROGRAMMED LINE INTEGRITY TESTS: ❑ a. MINIMUM MONTHLY 0.2 g.p.h. ❑ b. MINIMUM ANNUAL 0.1 g.p.h. M42. WILL ELLD DETECTION OF A PIPING LEAK TRIGGER AUTOMATIC PUMP SHUTDOWN? ❑ a. YES ❑ b. NO M43. WILL ELLD FAILURF/DISCONNECTION TRIGGER AUTOMATIC PUMP SHUTDOWN? ❑ a. YES ❑ b. NO M44. ® 4. INTEGRITY TESTING TEST FREQUENCY: ® a. ANNUALLY ❑ b. EVERY 3 YEARS ❑ c. OTHER (Specify) M45. M46. ❑ 5.VISUAL MONITORING DONE: ❑ a. DAILY ❑ b. WEEKLY* ❑ c. MIN. MONTHLY & EACH TIME SYSTEM OPERATED** M47. * Requires agency approval ** Allowed for monitoring of unburied emergency generator fuel piping only per HSC §25281.5(b)(3) ❑ 6. PIPING IS SUCTION PIPING MEETING ALL REQUIREMENTS FOR EXEMPTION FROM MONITORING PER 23 CCR §2636(a)(3) ❑ 7. NO PRODUCT OR REMOTE FILL PIPING IS CONNECTED TO THE UST(s) ❑ 99, OTHER (Specify) Mas. UN -022A -1/3 www.unidocs.org Rev. 10/14/03