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NIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN- Pse I 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) I I I _ - 1 BUSINESS NAME(Same as FACILITY NAME) 5v P C e, S T O P <. ," c�, L 1° tJl1e,. 3_ BUSINESS SITE ADDRESS L CI'© f j M,41'W 5 T -_# G 103. CITY M,4N T`C-4 , 104. U.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 EQUIPMENT IS SERVICED ANNUALLY ❑ 99.OTHERS i 490.34 MONITORING E Q (Specify): 490.317 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 TEE FOLLOWING METHOD(S): _EVCONTINUOUS 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: jo a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED ❑d.UNDER VACUUM 490-6 PANEL MANUFACTURER: V e 9;>e tZ 'P oc>T• 4W7. MODEL#: ` i_S -3-19-0 490"s LEAK SENSOR MANUFACTURER: %/1►OG t2. tZ 0647. 490-9. MODEL#(S): 20 490-10 AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).(23 CCR§2643) 49x11 PANEL MANUFACTURER: Vf."e_v -`lt+v j' 490-12 MODEL#: -7 7 9-) 490-13 IN-TANK PROBE MANUFACTURER: + 490-14. MODEL#(S): h/1 490-15 LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY 490-16 ❑ d.MONTHLY ❑ e.OTHER(Specify): 490-17 490.18 PROGRAMMED TESTS: ❑ a.0.1 g.p.h. ❑ b.0.2&p.h. ❑ c.OTHER(Specify): 490.19 ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 49x20 ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§2645). TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS 490-21 490.22 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 490.23 TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): 490"24 490-25 ❑99.OTHER (Specify): 490.26 490-27 V.PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) CONTINUOUS MONITORING OF PIPE/PIPING SUMPS)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 490-28 VISUAL ALARMS. (23 CCR§2636) ✓ SECONDARY CONTAINMENT IS:91 DRY ❑b.LIQUIDFILLED 0c.PRESSURIZED ❑d.UNDER VACUUM 490-29 PANEL MANUFACTURER V E r:D e A '-p-00-r. 49030 MODEL#: L S 3S%> 49x31 LEAK SENSOR MANUFACTURER: V67rz_&C�, 490-321 MODEL#(S): 2_G9 4W33 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. [�X YES ❑b.NO 490-34 FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. C1 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 CCR2636 T 90-3 MLLD MANUFACTURER(S): ke_'b Tq C*_e_ 49x37 MODEL#(S): F X ( %qj 0 ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 gp h.LEAK TESTS (23 CCR§2636) 490-39 ELLD MANUFACTURER(S) 490.40. MODEL#(S): 490.41 PROGRAMMED IN LINE LEAK TEST: ❑ 1.MINIMUM MONTHLY 0.2 g.p.h. ❑ 2.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 49044 4.PIPE INTEGRITY TESTING 49o45 TEST FRE UENCY 0 a.ANNUALLY 0 b.EVERY 3 YEARS c.OTHERS i 490-46490.17 El 5.VISUAL PIPE MONITORING. 490-48 FREQUENCY ❑ a.DAILY ❑ b.WEEKLY ❑C.MIN.MONTHLY&EACH TIME SYSTEM OPERATED- 490-49 "Allowed for monitoring of unburied emergency gamaw fuel piping ordy per HSC 25281.5(bX3) ❑ 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 490-51 ❑ 99.OTHER(Specify) 490-52 49453 UPCF UST-D(12/2007)114