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• UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN- Pae 1 of 2) TYPE OF ACTION ❑ 1.NEW PLAN 2.CHANGE OF INFORMATION 490-1. PLAN TYPE 1.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. 490-z. (Check one item only) ❑ 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) BU ESS NAME(Same as Facility Name or DBA) 3. coINJtj-r vr> FtbD V f.l. BUSINESS SITE ADDRESS 103. CITY s o J r l 104. US(, CooNom-Y J'b &i--c> ceR^C7�1 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 __bb the a ui ment manufacturers'instructions,or annually,whichever is more frequent:Such work must be performed by_qualified personnel:.[23 ccR§2632,2634.2638,2641] .....----q._.p....__................ .._..._._...._...- .._..__........__.. __ MONITORING EQUIPMENT IS SERVICED 1.ANNUALLY ❑ 99.OTHER S eci fy) a90-3490-3a.( p : 490-36. III. MONITORING LOCATIONS ❑ 1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN ['} 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED [23 CCR§2632,26341 4904. IV. TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) that apply) 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) 49-5. WITH AUDIBLE AND VISUAL ALARMS.[23 CCR§2632,2634] SECONDARY CONTAINMENT IS:� /X a.DRY [Ib.LIQUID FILLED El c.PRESSURIZED _' (❑ d.UNDER VACUUM 490-6. V PANEL MANUFACTURER: tkb�`- O-T 490-7. MODEL#: L4 TV-1;> 'C 490-8. LEAK SENSOR MANUFACTURER 490-9. MODEL#(S): aZ 490-10. ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).[23 CCR§2643] 1/r 490-12. 490-13. PANEL MANUFACTURER: ay��Fc-=is�d��s- MODEL#: IN-TANK PROBE MANUFACTURER: 490-14. MODEL#(S): 490-15. LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY 490-16. ❑ d.MONTHLY ❑ e.OTHER(Specify): 490-17. 490-18. PROGRAMMED TESTS: El a.0.1 g.p.h.__...-.__........_[I b.0:2 g.p.h. El C_OTHER(Specify): _. 490.19. _..... ....__......_.-_....---........_.._-................�....__._...... 490-20. El3.MONTHLY STATISTICAL INVENTORY RECONCILIATION[23 CCR§2646.1] -._......_..-......_...._ ._.....----.......--......-_....._-.......__.............-...._.........._...._....-......_................-............-...........�......__.-.........-.....-...-............-_........_-...........-................-._.............-_.....---....._... ❑ 4.WEEKLY MANUAL TANK GAUGING MTG [z3 CCR§2645] TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS 49421. ( ) 49-22,-- ❑ 5.TANK INTEGRITY TESTING PER[23 CCR§2643.1] 490-23. 490.24. TEST FREQUENCY: ❑ a.ANNUALLY -❑ b_BIENNIALLY ❑ c.OTHER (�cify)_ 490-25__, ... . 490.26. ❑ 99.OTHER(Specify): 490-27. V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) th,tea�tl) 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE&VISUAL ALARMS. 490-21. [§26CCR 36] SECONDARY CONTAINMENT IS: R a.DRY [Ib.LIQUID FILLED Elc.PRESSURIZED Eld.UNDER VACUUM 490-29. PANEL MANUFACTURER: VP_1:zL _ iZOU490-30. MODEL#: TLS TC-0 490-31. LEAK SENSOR MANUFACTURER: V eEvix- Zoo r 490-32. MODEL#(S): ZU 490-33. PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. a.YES ❑ b.NO 490-34. FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. f a.YES ❑ b.NO 490-31. - ...._ .....__...........�_....._...-_...._.....- -...... ...........-..._.... -..........-...._ -...........-....._._.-..._....._._...........- ........___....._....-...._.....--..... -......-- _--_ 2.MEANICAL LINE LEAK DETECTOR(MLLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS AND RESTRICTS OR SHUTS OFF 49-36• CH PRODUCT FLOW WHEN A LEAK IS DETECTED.[23 CCR§26361 MLLD MANUFACTURER(S): 490-37. MODEL#(S): FX (NA 490.38. ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS.[23 CCR§26361 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. 49042. 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 490-44. _ -_.....-....-......_.....-- ....----.....---......._-....._-..._._..-..........-..........._..._..._.....-..................._... ........-.................-.. -...... - .._..._-.__...._ ............._-._._....._-..........._._-..._........._-._._..___. ❑ 4.PIPE INTEGRITY TESTING. 490 as. TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(. Pe fy)S ci a90 46. �._..._-_......_.-..........__..........-_...._._-.._.__.-.....-- -..........--._...._._..-._..............-._................_._............ -_.._....__.-..._......._..-_... ❑ 5.VISUAL PIPE MONITORING. ago-as. FREQUENCY: ❑ a.DAILY ❑ b.WEEKLY ❑ c.MIN.MONTHLY&EACH TIME SYSTEM OPERATED' 490-a9. _. _-.._..._....-.._....._---.....__-_.....-......._-._.....----"--_-....._..-........._-......__.� . •Allowed for monitoring of unburied emergenncy generator fuel pi iP ng only ep r HSC•.§25281.5(ti�i3�„-,,,,,.,,-.....,... ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA.123 CCR§2636(a)(3)] 49480. --...._..-..........-.._.......--....._...- . ................---............_._._._.........--..._..........._........,_....-..__... _..... .....�__...._._-......_-......_.._ _...-...._._ .........�_.....__.- ..._.-_. ...... ❑ 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM. 490 St .........-.............._-.._.._.....__..._..........._......_.............-_........----......---....._....-............- .......__.-_._....._._-_.._.....__.._..................-._......___.._.....--._......_..._ .....--..... .... ago-sz. ❑ 99.OTHER(Specify) 490-53. UPCF UST-D(12/2007)-1/4 www.unidoes.org