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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN - age 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. 490-2. (Check one item only) ❑ 2. THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): I. FACILITY INFORMATION FACILITY ID # (Agency Use Only) BUSINESS NAME (Same as Facility Name or DBA) 3. LOw�Vr oter'*jj"? .,des QI�Q✓fie✓► BUSINESS SITE ADDRESS 103. CITY 104. la%® 7 rOG Orf 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 by the equipment manufacturers' instructions, or annually, whichever is more frequent_ Such work must be performed b)Lqualified personnel_ 123 CCR §2632, 2634, 2638, 26411 MONITORING EQUIPMENT IS SERVICED 1. ANNUALLY ❑ 99. OTHER (Specify): 490-3b. III. MONITORING LOCATIONS ❑ 1. NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN 0 2. SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED 123 CCR §z63z, 26341 4900.. IV. TANK MONITORING IS PERFORMED USING THE FOLLOWING METHODS (Che ' that a I ❑ 1. CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR (INTERSTITIAL) SPACE(S) OR SECONDARY CONTAINMENT VAULT(S) 490-5. WITH AUDIBLE AND VISUAL ALARMS. 123 CCR §2632, 26341 SECONDARY CONTAINMENT IS: X a. DRY ❑ b. LIQUID FILLED ❑ c. PRESSURIZED ❑ d. UNDER VACUUM 490-6. PANEL MANUFACTURER: 490-7 MODEL #: 490-8. LEAK SENSOR MANUFACTURER: 490-9. MODEL #(S): 490-10' ❑ 2. AUTOMATIC TANK GAUGING (ATG) SYSTEM USED TO MONITOR SINGLE WALL TANK(S). 123 CCR §26431 490-11. PANEL MANUFACTURER: 490-12. MODEL #: 490-13. 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. PROGRAMMED TESTS: ❑ a. 0.1 h. ❑ b. 0.2 h. El c. OTHER S ecif 490-18. 3. MONTHLY STATISTICAL INVENTORY RECONCILIATION [23 CCR §2646.11 490-20. ❑ 4. WEEKLY MANUAL TANK GAUGING (MTG) t23 CCR §26451 TESTING PERIOD: E]a. 36 HOURS ❑ b. 60 HOURS ago-zl. ago-zz. (� 5. TANK INTEGRITY TESTING PER t23 CCR §2643.11 490-23. TEST FRE UENCY: a. ANNUALLY El b. BIENNIALLY El c. OTHERS 490 z0.. Q pecify):.. avo=zzs_._ ---- -- - --- ----- -- -- ---- - - ---- -- 99. OTHER (Specify): 49x26. ❑ ago -z7. V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) '1 ack 111 that 1. CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S) AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE & VISUAL ALARMS. 490-28, 2 36R SECONDARY CONTAINMENT IS: a. DRY ❑ b. LIQUID FILLED ❑ c. PRESSURIZED ❑ d. UNDER VACUUM 490-29, 1§26361I PANEL MANUFACTURER: 490-30 MODEL #: 490-31. LEAK SENSOR MANUFACTURER: ago -32. MODEL #(S):D� , 0.90-33. PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP i.e., TURBINE) SHUTDOWN. l l; -34. FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a. YES b -NO -/�0 3s. --- --- - _------------- ------------------------ - --- 2. MECHANICAL LINE LEAK DETECTOR (MLLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS AND RESTRIC S.QR SHUTS OFF 490-36. PRODUCT FLOW WHEN A LEAK IS DETECTED. 123 CCR§26361 490-37. 490-38. MLLD MANUFACTURER(S): MODEL #(S) J* - h" r- --- ------ --- - - -r � 490-39, 3. ELECTRONIC LINE LEAK DETECTOR (ELLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS. 123 CCR§26341 `1 1 �4 ELLD MANUFACTURER(S): 490-40. MODEL #(S): ` ` ° "r d i 5;; ri ;?j + 490-41. PROGRAMMED IN LINE LEAK TEST: ❑ a. MINIMUM MONTHLY 0.2 g.p.h. ❑ b. MINIMUM ANNUAL 0.1 g.p.h. -1. 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 490-44. - ---- ------------- ..- ........ .............. -...... .---............ ---------------------------------._.._._.. Qf 4. PIPE INTEGRITY TESTING. 49045. TEST FREQUENCY_ a. ANNUALLY_ [Ib. EVERY 3 YEARS ❑ c. (Specify) -494-4907x6. -OTHER ❑ 5. VISUAL PIPE MONITORING ago as. FREQUENCY: ❑ a. DAILY ❑ b. WEEKLY ❑ C. MIN. MONTHLY & EACH TIME SYSTEM OPERATED" 49049. Allowed for monitoring of unburied emergency generator fuel piping only HSC §2g1ij., @)0 ❑ 6. SUCTION PIPING MEETS EXEMPTION CRITERIA. l23 CCR §2636(a)(3)1 490-50. ❑ 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) 490-53.90-52. UPCF UST -D (12/2007) -1/4 www.unkloes.org