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03102/2012 03:38 9252920074 GDF-SOLUTIONS FAX PAGE 04/15 Mk An UNIFIED PROGRAM CONSOLIDATED FO UNDERGROUND STORAGE TANK MONITORING PLAN/-(Page 1 o(2) TYPE OF ACTION ❑1.NEW PLAN ® 2.CHANGE OF INFORMATION 4904 PLAN TYPE ® 1.MONI TORINO IS IDENTICAL FOR ALI,USTS AT THIS FACILITY. 490.2 (Cheok one item only) ❑ 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEMOs u L FACILITY INFORMATION FACILITY ID#(Agency Use 04) 1 BUSINESS NAME(Same.=FACILITY NAME) Country Club 76 3 BUSWESS s1TB ADDRESS 2575 Country Club Blvd. 103 CITY Stockton 104' 11.EQUIPMENT TESTING AND PREVEN M MAINTENANCE Testing,prevotive mointenmrc,and calibration of monitoring copment te.g.,sensors,probes,line leak detectors,etc.)must be performed at the frequency specified by the equipment rnamifaCt+um'iastmWons,or annually,whichever is more frequcnt,sod that smtch work must be pe& med by qualified personnel. 23 CCR 2b32 2634 2638 2641 490- MONITORING EQU0nWV%rF IS SERVICED ® 1.ANNUALLY [1 99,OTHER(Specify): s9a e TIL MONITORING LOCATIONS �]L NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. ®2.SITE PLOT PLAMMAP PREVIOUSLY SUBMITTED. (23 CCR#2632, 2634 9o.4 TV.TANK MONTI'ORI NG IS PERFORMED USING THE FOLLOWING METEIOD(S): 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTA(NMENT 490-5 VAULT(S)WITH AUDIBLE AND VISUAL ALARMS. (23 CCR$12632,2639) SECONDARY CONTAINMENT IS: ❑ a.DRY ® b.LIQUID FILLED ❑ c.PRESSURtZEE) ❑d.UNDER VACUUM 490..6 PANEL MANUFACTURER: Veeder Root490-7 I MODEL#. TLS-35OR 40" ER: LEAK SENSOR MANUFACTURVeeder Root .M_...490-9, MODEL#(S): 794380-420 490-10 2 AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALT.TANK(a(23 CCR}2643) 490-11 PANEL MANUFACTURER: 890612. MODOL 4: 490-13 IN-TANK PROBE MANUFACTURER: 490.18. MODEL 0(8): 49oas LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ a WEEKLY 490.16 q d.MONTHLY ❑ e.OTHER(Spccify): 490-17 PROGRAMMSD TESTS: ❑ a.0.1 g.p.h. ❑ b,0.2 S.p.h. ❑ m OTHER(Specify): 490-10 490-f9 ❑ 3.MONT19LY STATISTICAL INVENTORY RECONCILIATION(23 CCR¢2646.1); 49aso ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR$2645). TFSTiNG PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS 49421 4 S.TANK INTL;GRUY TESTING(23 CCR$2643.1): 4W23 "TEST MEQUENCY: D a ANNUALLY ❑ b.BIENNIALLY ❑ e.OTHER(Specify): 49044 M 02699.OTIMR !S�c1fy)�_SaDIICIty a27 V.PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHODS)(Cheek all that apply) 1.CON 17NUOUS MONITORING OF PIPE1 P PING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 7495 VISUAL ALARMS. (23 CCR§2636) SECONDARY CONTAINMENT IS:®a.DRY Mb,LIQUID FILLEP ❑c.PRESSURIZED [3d.UNDER VACUUM 49429 PANEL MANUFACTURER: Veeder Root 490.30 MODEL#: TLS-3508 990-31 LEAK SENSOR MANUFACTURER: Veeder Root 99032 MODEL#(S): 794380-208/304 "0.33 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. ®A,YES ❑b.NO �.... 490.34 FAILURE/DISCONXtCTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ®a.YES ❑b.NO 49035 2,MECHANICAL LINE LEAK DETECTOR(MLLD)THAT ROVnNELY PERFORMS 3.0 g.p,h.LEAK TESTS AND RESTRICTS OR SMUTS OFF PRODUCT FLOW WHIN A LEAK IS DETECTED JR CCR 636 490-36 MLLD MANUFACTURf3t(s): 87-Vs orless/91&Diesel-/Zed Jacket 440.37 MODEL#(S): LD20001F'XIV 49(638 ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS (23 CCR#2636) 490.39 ELLD MANUFACTURER(S) -�' w. 49040MODEL#(S): 49041 PROGRAMMED IN LINE LEAK TEST: ❑ I.MINIMUM MONTHLY 0.2 g p,h. ❑ 2.MINIMUM ANNUAL 0.1 g p.h............... 490.43 ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHLM)OWN. U a.YES ❑b.NO 490.43 ELLD FAILURUDISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. 17 a.YES ❑b.NO 490J4 El 4.PIPE INTEGRITY TESTING 49,45 TEST FRE UENCY 0 a.ANIQUALLY 0 b.EVERY 3 YEARS 0 c.OTHERs ci 400-6 490.47 5.VISUAL PIPE MONTrORING. 4N.41 FREQUENCY ❑ a.DAILY ❑ b.WEEKLY ❑c.MIN.MONTRLY dt EACH TIME SYSTEM OPERATED- 490-49 •Allowed ibr mm ofYdwdod/m Biel$.�Ig only pew HSG 252$1. ❑ 6.STICTION PIPING MEETt3 O MPTION CRITERIA 123 CCR§2636(x)(3)]. 490.5o 7.NO REGULATED PIPING PER HEALTH AND SALTY CODE.DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM 490.9 t �p� 99.OTHER(Specify49o.S2) Am" LUST Response Plan(3/2006)3!J