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• UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN - (Pae 1 of 2) IYPE OF ACTION ❑ I NEW PLAN [g 2. CHANGE OF INFORMATION 490-1 PLAN TYPE ❑ 1 MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY 490-2 (Check one item only) ❑ 2 THIS PLAN COVERS ONLY THE FOLLOWING USI SYSTEM(S): IFACILITY-FIFORIVTATION FACILITY ID # (Agency Use Only) 1 BUSINESS NAME (Same as Facility Name or DBA) 3 R � a?0 �-I BUS aoa °wss-�a+�►r vie l03 CIT cA- qs o 104 ;, Il . EQ}PM7x T", t"ST 00ANf PRETYVF lTETE .., .. . . 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 ui ment manufacturers' instruct_io_ns, or annually, whichever is more frequent Such work must be performed by qualified personnel. ccR §z63z, z63a, z638 z64q -_ �P - - ------ - MONITORING EQUIPMENT IS SERVICED ® 1. ANNUALLY ❑ 99.OIHER S ci 490.70 Q ( Pe fY): 490-36. r Ti ''�{'''`' 77pp�,�++' 4 y,4 y •'i� i # i �"S ��"k'T F ! f�� ! hC:1 P 'fe E� Q•i } ❑ 1 NEW SITE PLOT PLAN/MAP SUBMIITED WIIH THIS PLAN 2 SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED (23 CCR §2632, 263341 4904 0-4 �CY�\�.�,G��.� a K�... � y+:i"v+Fw�'�i.'R��--SS��•a�� : F 4�. ': R ' � �i 1 CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR (INTERSTITIAL) SPACE(S) OR SECONDARY CONTAINMENT VAULT(S) 490.5 WITH AUDIBLE AND VISUAL ALARMS [23 CCR J2632,2634] SECONDARY CONTAINMENT IS: C4 a DRY b. LIQUID FILLED ❑ c PRESSURIZED [Id UNDER VACUUM 490-6 L❑ PANEL MANUFACTURER: Y ef- T 490.7 MODEL #: M.:Et 3 090-8 LEAK SENSOR MANUFACIURER: � 0& 411 MODEL 490-10 _ ❑ 2 AUTOMATIC TANK GAUGING (ATG) SYSTEM USED TO MONITOR SINGLE WALL TANK(S) [23 CCR §26431 090 n PANEL MANUFACTURER: 49012 MODEL #: 490-13 IN -TANK PROBE MANUFACTURER: 490-14 MODEL #(S): 490-15 LEAK TEST FREQUENCY: ❑ a, CONIINUOUS ❑ b DAILYINIGHTLY ❑ c WEEKLY 490-16 ❑ d MONTHLY ❑ e OTHER (Specify): 490-17 490.18 PROGRAMMED IESIS: a. 0 1 �Q.h b: 0:2 pp h: c_ OTHER (Specify): 490-19:-. _ _ _ __.._❑ - - _0. . _ ._.El ❑ 3. MONTHLY STATISTICAL INVENTORY RECONCILIATION (23 CCR §2646.11 490-20 ❑ 4. WEEKLY MANUAL TANK GAUGING (MTG) [23 CCR §26451 TESTING PERIOD: ❑ a. 36 HOURS ❑ b. 60 HOURS 490-n.zl ❑ 5 TANK INTEGRIIY TESTING PER (23 CCR §264311 490-23 490.24 TES T FREgUENCY: ❑ a ANNUALLY ❑ b. BIENNIALLY ❑ c. OTHER(Specify).-� 490-25. - 99. OTHER (Specify): 09026 ❑ a9art. ... ._ ., ...cif• ..;� .:.- - s_ ,. ,. ,, '-...,. v� yu ^>-�, t i ® 1 CONTINUOUS MONITORING OF PIPEIPIPING SUMP(S) AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE & VISUAL ALARMS 490-28 [23CCR1 SECONDARY CONTAINMENT IS: Q a DRY [3b. LIQUID FILLED ❑ c PRESSURIZED El UNDER VACUUM 490-29 L 490-31 490.10 MODEL #: TLS PANEL MANUFACTURER: _ LEAK SENSOR MANUFACTURER: Q 490-32 MODEL #(S): 490-13 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP (i e, TURBINE) SHUTDOWN ❑ a. YES ❑ b NO 490-14 FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS TI_C PUMP SHUTDOWN._ ❑ a. YES ❑ b. NO_ 490.35 _ _ _AU_TO_MA_ ❑ 2. 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§2636] .11 -MLLD MANUFACTURER(S): _ 490.37 MODEL #(S)_ 490-38 ❑ 3 ELECTRONIC LINE LEAK DETECTOR (ELLD) THAT ROUTINELY PERFORMS 3 0 g p h LEAK TESTS (23 CCR§26361 090.39 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 49043 ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a. YES ❑ b. NO 490-x4 ❑ 4 PIPE INTEGRITY TESTING 45 TEST FREQUENCY: ❑ a. ANNUALLY ❑ b. EVERY 3 YEARS ❑ c. OTHER (Specify) 8949900-46 ❑ 5. VISUAL PIPE MONITORING 490.48 FREQUENCY: ❑ a DAILY ❑ b, WEEKLY ❑ c MIN MONTHLY & EACH TIME SYSIEM OPERATED* 490.49 'Allowed for _monitori�of'tmburied.emer.ey-m-egoofueAtpAa��erHSCL2528LSLZ(3Z,_.--_ -.._.-._._SUCII-.-_.N_.P_.I__ING____MEETS___--EXE___.--PTIO__.CRITERIA_____-_.__._. ❑ 6. OPMN [23 CCR §2636(ax3)1 490-50. ❑ 7. NO REGULAIED PIPING PER HEALTH AND SAFETY CODE, DIVISION 20, CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM. 490-51 ❑ 99. OTHER (Specify)490-53.05 UPCF UST -D (12/2007) - 1/4 www.unid0C3.0fg