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0 4 UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUNDSTORAGETANK MONITORING PLAN-(Page I of 2) TYPE OF ACTION ❑ 1.NEW PLAN ❑ 2.CHANGE OF INFORMATION 4900 PLAN TYPE 1&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)- 1. FACILITY INFORMATION FACILITY ID#(Agency Use Only) 1 BUSINESS NAME(Same as FACILITY NAME) *� �� 3_ BUSINESS SITE ADDRESS 601 ��7"��/vl 103' CITY --b; 95:-f Or 104- H..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,and that such work must be performed by qualified personnel. (23 CCR§2632,2634,2638,2641 MONITORING EQUIPMENT IS SERVICED I.ANNUALLY ❑ 99.OTHERi 490-3 Q (SPce fy): 490-36b M.MONITORING LOCATIONS ❑1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. K2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 2634)490-t IV.TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT 490-5 VAULT(S)WITH AUDIBLE AND VISUAL ALARMS. (23 CCR§2632,2634) SECONDARY CONTAINMENT IS: ❑ a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED ❑d.UNDER VACUUM 490-6 PANEL MANUFACTURER: g 490'7' MODEL#: 3- <;_ 49" LEAK SENSOR MANUFACTURER: 4 MODEL#(S): q07 490-10 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).(23 CCR§2643) 49041 PANEL MANUFACTURER: 490.12 MODEL#: 490-13 IN-TANK PROBE MANUFACTURER: 414. MODEL#(S): 490-15 LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY 490'16 ❑ d.MONTHLY ❑ e.OTHER(Specify): 49047 PROGRAMMED TESTS: ❑ a.0.l h. ❑ b.0.2 h. ❑ c.OTHERS if 490-18 g•P• g•P• (Specify): 490-19 ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 490-20 ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§26457. TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS 490.21 490.az 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 490-23 TEST FREQUENCY: [Ia.ANNUALLY ❑ b.BIENNIALLY Elc.OTHER(Specify): 141 490-24 49025 490-26 ❑ 99.OTHER (Specify): 490,-27 V.PIPE MONITORING IS PERFORMED USING WE FO1J,0VdNG METHOD(S)(Check all that apply) I.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 490.29 VISUAL ALARMS. (23 CCR§2636) SECONDARY CONTAINMENT IS:Ka.DRY ❑b.LIQUID FILLED ❑c.PRESSURIZED ❑d.UNDER VACUUM 490-29 PANEL MANUFACTURER: 49030 MODEL#: 490-31 LEAK SENSOR MANUFACTURER 412 1 MODEL#(S): :2_0 490-33 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. 30 a.YES ❑b.NO 490-34 FAILUREMISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. Ka.YES ❑b.NO 490-35 ❑ 2.MECHANICAL LINE LEAK DETECTOR(MLLD)THAT ROUTINELY PERFORMS 3.0 g.p h.LEAK TESTS AND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK IS DETECTED 23 CCR§IL3490-36 MLLD MANUFACTURER(S): 4990-37 MODEL#(S): 490.38 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS (23 CCR§2636) 490-39 ELLD MANUFACTURER(S) 4�40' I MODEL#(S): PL. 4l0 41 PROGRAMMED IN LINE LEAK TEST: ❑ 1.MINIMUM MONTHLY 0.2 g.p.h. ❑ 2.MINIMUM ANNUAL 0.1 g.p.h. 490.42 ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. CW a.YES ❑b.NO 490.43 ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. K4.YES ❑b.NO 490.44 4.PIPE INTEGRITY TESTING 49045 TEST FREQUENCY t9 a.ANNUALLY b.EVERY 3 YEARS ❑ c.OTHER(Specif 49046490-47 5.VISUAL PIPE MONITORING. 49048 FREQUENCY [,a.DAILY ❑ b.WEEKLY ❑C.MIN.MONTHLY&EACH TIME SYSTEM OPERATED- 49049 .Allowed for=nitoring of unburied wwriiency gammor fuel piping only per HSC 25281.5(bM3) ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR§2636(x)(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) 49052 490-53 UPCF UST-D(12/200')1/4