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IFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN - Page 1 of 2) TYPE OF ACTION ❑ 1. NEW PLAN ® 2. CHANGE OF INFORMATION ago -I 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 SYS'TEM(�)_ I. FACILITY INFORMATION FACILITY ID # (Agency Use Only)- - - BUSINESS NAME (Same as FACILITY NAME) Shell & Mini Mart # 136186 3 BUSINESS SITE ADDRESS 3725 N. Tracy Boulevard 103 CITY Tracy 104 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, and that such work must be performed by qualified personnel. 23 CCR §2632.2634, 2638, 2641) MONITORING EQUIPMENT IS SERVICED ® 1. ANNUALLY ❑ 99. OTHER (Specify): 490-3a 490-3b III. MONITORING LOCATIONS ❑ 1. NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. ® 2. SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR §2632, 2634)49o -4 -_..---- IV. TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): I. CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR (INTERSTITIAL) SPACE(S) OR SECONDARY CONTAINMENT ago -s I VAULT(S) WITH AUDIBLE AND VISUAL ALARMS. (23 CCR §2632,2634) SECONDARY CONTAINMENT IS: ❑ a. DRY ® b. LIQUID FILLED ❑ c. PRESSURIZED El d. UNDER VACUUM 490-6 ---------- ----- ------------------ --------------------------- ------------------------------------------------------------------------- ----------------------------------------------------490---- 490-7-1-------------------- PANEL MANUFACTURER_ Veeder Root I MODEL #: TLS -350R 490-8 -------------------------------------I--------------------------------- -------------------- ------ - - - LEAK SENSOR MANUFACTURER Veeder Root 490-9 ; MODEL #(S): 794380-301 49010 ❑ 2. AUTOMATIC TANK GAUGING (ATG) SYSTEM USED TO MONITOR SINGLE WALL TANKIS). (23 CCR §2643) 490-: t PANEL MANUFACTURER: 490-12. MODEL #: 490------ - --- - - -- -------------------------------- ------------------- - - ----- ------------ --------------------------------------------------------------------------------------5---------------------------------------------------------------------------15 1N -TANK PROBE MANUFACTURER: 490'14 MODEL #(S): 490 -IS - - ---,------------ ----- ----------- ------------------------ - - - - --- - LEAK TEST FREQUENCY: ❑ a. CONTINUOUS ❑ b. DAILY/NIGHTLY ❑ c. WEEKLY 490-16 ❑ d. MONTHLY ❑ e. OTHER (Specify): - ------------------ 490-17 --------------------------------------------------- - - ---------------------------- - - - - --18 PROGRAMMED TESTS: ❑ a. 0.1 h. ❑ b. 0.2 h. ❑ c. OTHER (Specify): g.p.h. g.p.h. Y 490-19 490-I9 ❑ 3. MONTHLY STATISTICAL INVENTORY RECONCILIATION (23 CCR §2646.1): 490-20 F-14. WEEKLY MANUAL TANK GAUGING (MTG) (23 CCR §2645). TESTING PERIOD: ❑ a. 36 HOURS ❑ b. 60 HOURS 490-21 490-zz ❑ 5. TANK INTEGRITY TESTING (23 CCR §2643.1): 490-23 TEST FREQUENCY: ❑ a. ANNUALLY El b.BIENNIALLY ❑ c. OTHER (Specify): 490-2s ® 99. OTHER (Specify): Simplicity 490-26 490-27 V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply) ® I. CONTINUOUS MONITORING OF PIPE/ PIPING SUMP(S) AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 490 z9 VISUAL ALARMS. (23 CCR §2636) SECONDARY CONTAINMENT IS: ®a. DRY []b. LIQUID FILLED [1c. PRESSURIZED ❑d. UNDER VACUUM 49°-z9 ------------ ----------- - - - - - - - - - - -• - - - - PANEL MANUFACTURER: Veeder Root 490.10 j MODEL #: TLS -3508 490-31 - ------ ----------------------------------- ------- -- ------------------------------------------------------------ - - - - - - 490-32 _---• LEAK SENSOR MANUFACTURER: Veeder Root MODEL #(S)_ 794380-208 490-33 -PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP (i.e., TURBINE) SHUTDOWN. ® a. YES ❑ b. NO 490-14 FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ® a. 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 j2636) 490-36 - MLLD MANUFACTURER(S): 0-9°-37 MODEL #(S): 490-39 ® 3. ELECTRONIC LINE LEAK DETECTOR (ELLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS (23 CCR §2636) -490.39 ----------------------------------------------------------------------------------------------------------------------------------------1------------'-'---------------------------------- 490-40. ELLD MANUFACTURERS) Veeder Root ;MODEL #(S): 8484 490-41 PROGRAMMED IN LINE LEAK TEST: C] 1. MINIMUM MONTHLY 0.2 g.p.h. El 2. MINIMUM ANNUAL 0.1 g.p.h. 4 90-42 ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ® a. YES ❑ b. NO 490-43 ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑O a. YES ❑ b. NO 490-44 ❑ 4. PIPE INTEGRITY TESTING 490.45 I TEST FREQUENCY ❑ a. ANNUALLY ❑ b. EVERY 3 YEARS ❑ c. OTHER (Specify) 490-46490-47 ❑ 5. VISUAL PIPE MONITORING. 49048 FREQUENCY ❑ a. DAILY ❑ b. WEEKLY ❑ c. MIN. MONTHLY & EACH TIME SYSTEM OPERATED- 490.49 j " Allowed for monitoring of unburied emergemy jpemrator fuel piping only per HSC §25281,5(b)(3 ❑ 6. SUCTION PIPING MEETS EXEMPTION CRITERIA 123 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 490-5I 490-52 ❑ 99. OTHER (Specify) 490-53 UPCF UST -D (12/2007) 1/5