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i ECEIVED UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MAY 2 4 2013 MONITORING PLAN-(Page 1 of 2 TYPE OF ACTION ❑1.NEW PLAN CHANGE OF INFORMATION E 490-1 PLAN TYPE VPI.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. (Check one item onT 2,THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM( • J. *AM'.Y INFORMATIQN`. FACILITY ID#(Agency Use Only) BUSINESS NAME(Sante as FACILITY NAME) 3. BUSINESS'SITE nDDRESs %-?,t � � 103. CITY 104• II,EQUIPMENT TESTING AND PREVENTM MAIN.TENANGE Testing,preventive maintenance,and calibration of monitoring equipment(e.g.,sensors,probes,linc:leak detectors,etc.)must be performed at(hc frequency specified by the equipment manufacturers'instructions,or annually,whichever is more frequent,and that such work must be performed by qualified personnel. 23 CCR§2632,204,2638,2641 MONITORING EQUIPMENT IS SERVICED 'L ANNUALLY ❑ 99.OTHER(Specify): 49"a 490.36 TIL MOINITORINGLOCATIONS ❑1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH Tffi5 PLAN. SITE PLOT PLANIMAP PREVI 363490-4 OUSLY SUBMITTED. (23 CCR'§2632, IV.TANK`MONITORING ISPERFORMED.USING:THE FULLOVYING-METHOD(S): - I.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT 490-5 VAULT(S)WITH AUDIBLE AND VISUAL ALARMS. (23 CCR§2632,2634) SECONDARY CONTAINMENT IS: ❑ a DRY &b.LIQUID FILLED ❑ C.PRESSURIZED ❑d.UNDER VACUUM 4906 PANEL MANUFACTURER: 1,7>�� 490-7. 0-90-9 2-t MODEL#: - 3s'�� LEAK SENSOR MANUFACTURER: u 49". 49a-1 MODEL#(S):�W'F 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL.TANK(S).(23 CCR§2643) 490-11 PANEL MANUFACTURER: - 49012. MODEL#: t 490-13 IN-TANK PROBE MANUFACTURER: 490-14' MODEL#(S): ( 49045 LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑b.DAILY/NIGHTLY ❑ c.WEEKLY 490-16 dMONTHLY ------ ❑ e.OTHER(Sp-ecify): 490-17 PROGRAMMED TESTS: ❑ a.0.1 g.p.h. ❑ b.0.2 g.ph. ❑ c.OTHER(Specify): i -�� 490.18 49949 ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 490-20 ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§2645). TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS 490-21 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 490-22 49023 TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): 499:24 490-2S ❑ 99.OTHER (Specify): 490-26. 490.27 V.PIPE MQNITOItING IS:PERFOR1VIlJD.U$;N THE FULLOvmG METFIOD(S);(Check A tha't::aPPiY) El 1.CONTINUOUS MONITORING OF PIPE(PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 490-29 VISUAL ALARMS. (23 CCR§2636) - SECONDARY CONTAINMENT IS:❑a_DRY ❑b.LIQUID FILLED ❑c.PRESSURIZED ❑d.UNDER VACUUM 490-29 PANEL MANUFACTURER: 4900-° MODEL#: ` 49x31 LEAK SENSOR MANUFACTURER: 490-32 MODEL#(S): 490-33 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. ❑a,YES ❑b.NO 490.34 FAILUREJDIS,CONNECTION 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 PRODUCT FLOW WHEN A LEAK IS DETECTED(23 CCR§2636) 490.36 MLLD MANUFACTURERS: 490-37--- 490 gs O MODEL#S): 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS (23 CCR§2636) 490.39 ELLDMANUFACTURERS) f-0-L 490.40. MODEL#(S): e4 Q--e DCT 4490-41 PROGRAMMED IN LINE LEAK TEST: J4 1.MINIMUM MONTHLY 02 g.p.h, ❑ 2.MINIMUM ANNUAL 0.1 gp.h. - 49042 ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. [mit YES ❑b.NO 490-47 ELLD FAILUREMISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. aia YES ❑b.NO 49044 ❑ 4.PIPE INTEGRITY TESTING 49a4s TEST FREQUENCY ❑ a_ANNUALLY b.EVERY 3 YEARS El c.OTHER(Specify) 490-46 49047 ❑ 5.VISUAL PIPE MONITORING. 49048 FREQUENCY ❑ a.DAILY ❑ b.WEEKLY ❑c.MIN,MONTHLY&EACH TIME SYSTEM OPERATED* 490-49 •Mowed for atonilorin orunburied me unemtor fuel piping only HSC 75281-5@ 3 ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA[23 CCR§2636(a)(3)]. 490.50 LJ 7.NO REGULATED PIPING PER HEALTH AND:SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM 490.51 ❑ 99.OTHER(Specify) 490 s2 490-53 UPCF UST-D(12/2007)114