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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN- (Page I ®f 2) TYPE OF ACTION ❑ 1.NEW PLAN "z 2.CHANGE OF INFORMATION ago 1. PLAN TYPE 1.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. 490-2- (Check 90-2(Check one item only) n 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): I. FACILITY INFOTION FACILITY_1D#(Agency Use-Only) RMA BUSINESS NAME(Same as Facility Vain or DBA) BUSINESS TE ADDRESS FJ'A j� - H'ii 6 ' j kv4 t03 1 CITY 104, I. 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 specific by the equipment manufacturers'instructions,or annually,._whichever is more frequent,Such_work must beperformedby qualified personnel.[23 CCR§2632,2614,2638,26411 490-3a. MONITORING EQUIPMENT IS SERVICED 'WI.ANNUALLY ❑ 99.OTHER(Specify): 490.3b. 111. MONITORING LOCATIONS 1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN El 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED [23 CCR§2632,2634, 490-4. (Check all IV. TANK MOthat apply) NITORING IS PERFORMED USING THE FOLLOWING METHOD(S) 1K I.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) 490-5 WITH AUDIBLE AND VISUAL ALARMS.[23 CCR§2632,26341 SECONDARY CONTAINMENT IS: %a.DRY El b.LIQUID FILLED ❑ c,PRESSURIZED El d.UNDER VACUUM 410-6. PANEL MANUFACTURER: C'm!atec 490-7, MODEL 9: _CUL 3 C&C' 490-8. LEAK SENSOR MANUFACTURER: i�mntpc_ 490-9, MODEL 4(S):CUT S 490-10. ❑ 1 2.AUTOMATIC I I TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL tA&KIS).[23 CCR§26431 490-11. PANEL MANUFACTURER: 490-12. MODEL#: 490-13 IN-TANK PROBE MANUFACTURER: 490-14. MODEL 4(S): 490-15. LEAK TEST FREQUENCY: El a.CONTINUOUS ffi7b DAILY/NIGHTLY ❑ c.WEEKLY 490-16, ❑ d.MONTHLY El e.OTHER(Specify): 490-17. 490-18, PROGRAMMED TESTS: El a.0.1 g.p.h. ❑ b.0.2 g.p.h. El c.OTHER(Specify): 4907.19_ ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION[23CCR§2646 1] 490-20❑ 490-21. 4.WEEKLY MAN-UAL TANK GAUGING(MTG)123 CCR§26451 TESTING PERIOD: 0 a.36 HOURS [Ib.60 HOURS 490-22, El 5.TANK INTEGRITY TESTING PER[23 CCR§2643.11 490-23 490-24, TEST FREQUENCY: El a.ANNUALLY [:1 b.BIENNIALLY F-1 c.OTHER(Specify): 490-25. _ 490.26. E3 99.OTHER(Specify): 490-27, (Cl V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) thahect ak pplaly) 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE&VISUAL ALARMS 490-28. [21 CCR SECONDARY CONTAINMENT IS: �a.DRY [I b.LIQUID FILLED 0 c.PRESSURIZED [I d.UNDER VACUUM 490-29, §26361 PANEL MANUFACTURER: Cro yAi`c 490-30. MODEL#: LEL'EUCS 1 490-31. LEAK SENSOR MANUFACTURER: nrnntec 4910-32, MODEL#(S): I=f-5; 490-33. PIPING LEAK ALARM TRIGGERS AUTOMATIC PUNT(i.e.,TURBINE)SHUTDOWN. jEr a.YES 0 K NO 11-14. FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. a.YES [Ib.No 490,35, K 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.(23 CCR§26361 490-37. 490-38, MLLDMANUFACTURER(S): k-��I lAIC�krL MODEL#(S): V F1 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS.t23 CCR§26361 490-39. ELLD MANUFACTURER(S): 49040, MODEL#(S): 490-41. PROGRAMMED IN LINE LEAK TEST: El a.MINIMUM MONTHLY 0.2 g.p.h. [I b.MINIMUM ANNUAL 0.1 g.p.h. 49042. ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. E] a.YES [I b.No 490-43 ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. El a.YES [I b.NO 190-44 ❑ 4.PIPE INTEGRITY TESTING. 49045. 490-46. TEST FREQUENCY: rl a.ANNUALLY 0 b.EVERY 3 YEARS ❑ c.OTHER(Specify) 49047 ❑ 5.VISUAL PIPE MONITORING. 490-48. FREQUENCY: ❑ a.DAILY [I b.WEEKLY El c.MIN.MONTHLY&EACH TIME SYSTEM OPERATED* 49049. .Allowed for monitoring oi�.jkoqd crnqi;eRcy.s9!!q4torf--1 piping ---------_ ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA.[23 CCR§2636(aX3)) 490-50. ❑ 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM. 490-51, 4W-52. ❑ 99.OTHER(Specify) 490-53. UPCF UST-D(12/2007)-1/4 www.unidocs.org