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ti UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN-(Page 1 of 2) 490-1. ITYPEOFACTION NEW PLAN ❑ 2-CHANGE OF INFORMATION 491>-z. PLAN TYPE ❑ 1.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. (Check one item onhv) ❑ 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): I. FACILITY INFORMATION FACILITY ID#(Agency Use Only _ _ 3. BUSINESS NAME(Same as Facilily Nante or DBA) 103. CI'T'Y 104. BUSINESS SITE ADDRESS r- 1 � f��-evl C (1- c- 11. 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 uen_t_S_uch work must be performed qualified personnel Iz3 cCR§2632_'A34.2619.26411 _ 490-3& MONITORING EQUIPMENT IS SERVICED ANNUALLY ❑ 99.OTHER(Specify): 490-3b. M. MONITORINATIONS 490-4. ❑ 1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED 123 CCR§3632 26341 (Check all . TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) that apply) CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTE ITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) 490-5. WITH AUDIBLE AND VISUAL ALARMS.ID CCR§2632.26341 490 6 SECONDARY CONTAINMENT IS: a.DIV,( r b.LIQ ID FILLED El c.PRESSURIZED ❑ d UNDER VACUUM C 490-7. MODEL#: T fiS` 3 ��/ 9040. PANEL MANUFACTURER: V C 490-9. MODEL#(S)_ 490-10. _ LEAK SENSOR MANUFACTURER: Li ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).123 CCR§26431 4 " PANEL MANUFACTURER: 490-1i MODEL#_ 490-13. IN-TANK PROBE MANUFACTURER: 49°x4. MODEL#(S): 490-15. LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY 490-16. 490-x7. ❑ d.MONTHLY ❑ e.OTHER(Specify): 490-19. _ PROGRAMMED TESTS: ❑ a.0.1 g.p.h. ❑ b.0.2 g.p.h. ❑ c.OTHER(Specify): 490-19. 490-20. ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION 123 CCR§2644.11 490-21. ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)123 CCR§26451 TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS _490-21 490-23. ❑ 5.TANK INTEGRITY TESTING PER 123 CCR§2643.11 490-24 TEST FREQUENCY: _ ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): 49x25._ 490-26. 490-27. ❑ 99.OTHER(Specify): (Check aU V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) that apply) 1_CONTINUOUS MONITORING OF PIPE/PIPWG SU AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE&' I ALARMS. 590-2R. 123 CCR SECONDARY CONTAINMENT IS: _ .LIQ 2D FILLED ❑ c.PRESSURIZED UNDER VACUUM 490-29 §26361 t (\ � '_ 31 __Z 490-31. PANEL MANUFACTURER: V � ✓ A F 490-30. MODEL#: 41 LEAK SENSOR MANUFACTURERI 90-32 MODEL#(S): J33. : /490-34 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. ES b.NO FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ES ❑ b.NO 490-35. [12.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.I23 CCR§'6361 490-3& 490'37. MODEL#(S): _ MLCD MANUFACTURER(S): -490-3 3.9 LECTRONIC A LINE LEAK DETECTOR(ELLD 00 1 ELY PEKFO� 1 (RMM 3 0 g.p.h.LEAK TESTS_1'-3 ccR§26361 _ _ ELLD MANUFACTURER(S): 7-o-+� 49' MODEL#(S): �? � PROGRAMMED IN LINE LEAK TEST: ❑ a.MINI M MONTHLY 0.2 g.p.h. ❑ b.MINIMUM ANNUAL 0.1 g.p.h. ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. M-9-YES ES ❑ b.NO 4 3' ELLD FA[LURFIDISCONNECT[ON TRIGGERS AUTO TIC PUMP SHUTDOWN. ES ❑ b.NO 490-14 -_-_ _. 490-05. ❑ 4.PIPE INTEGRITY TESTING. 490-16. TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(Specify) 490 4z__- _ 490-i9. ❑ 5.VISUAL PIPE MONITORING. FREQUENCY: ❑ a.DAILY ❑ b.WEEKLY ❑ c.MIN.MONTHLY&EACH TIME SYSTEM OPERATED' 490-09- •AUowed of inbiaitd epeatorCue1�Po8 adv er_HSC ?81.5@)«... _ ---- 490-50. ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA_123 CCR§2636(,x3)1 - ❑ 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(12/2007)-1/4 N'ww.unMas.org