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UNDERGROUND STORAGE TANK MONITORING PLAN For use by Unidocs Member Agencies or where approved by your Local Jurisdiction Authority Cited. Title 23 CCR, Sections 2632(d)(1), 2634(d)(2), and 2641(h) TYPE OF ACTION ❑ .NEW PLAN 2.CHANGE OF INFORMATION Mol. PLAN TYPE MONITORING IS IDE 1 AL FOR ALL USTs AT THIS FACILITY. M02. (Check one item only) ❑ THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) FACILITY NAME Moa. FACILITY SITE ADDRESS ' M04. CITY Mos. If EQUIPM NT TESTING AND PREVENTIVE MAINTENANCE State law requires that testing,preventive maintenance,and calibration of monitoring equipment(e.g.,sensors,probes,line leak detectors,etc.)be performed in Mob. accordance with the equipment manufacturers'instructions,or ann ally,whichever is more frequent. Such work must be performed by qualified personnel. MONITORING EQUIPMENT IS SERVICED ALANNUALLY ❑ 99.OTHER(Specify): M07. III. A40NITORING LOCATIONS This monitoring plan must include a Site Plan showing the general tank and piping layouts and the locations where monitoring is performed(i.e.,location of each sensor, line leak detector,monitoring system control panel,etc.). Ifyou already have a diagram(e.g.,current UST Monitoring Site Plan from a Monitoring System Certification form,Hazardous Materials Business Plan map,etc.)which shows all required information,include it with this plan. IV. TANK MONITORING MO ITORING IS PERFORMED USING THE FOLLOWING METHOD(S):(Check all that apply) MIO. 1.CONTINUOUS ELECTRONIC MONITORING 9F TANK ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) SECONDARY CONTAINMENT IS: a.DRY ❑ b.LIQUID FILLED ❑ c.UNDER PRESSURE ❑ d.UNDER VACUUM Mil. PANEL MANUFACTURER: M" MODEL#: -✓ M13. LEAK SENSOR MANUFACTURER: M14 MODEL#(S): IAM MI5. ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S) PANEL MANUFACTURER: M16. MODEL#: Mlz IN-TANK PROBE MANUFACTURER: MIs. MODEL#(S): M19. LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY M20. ❑ d.MONTHLY ❑ e.OTHER(Specify): M21. PROGRAMMED TESTS: ❑ a.0.l h. ❑ b.0.2 h. ❑ c.OTHER S eci M22. M23. g•p g p• ( P �') ❑ 3.INVENTORY RECONCILIATION ❑ a.MANUAL PER 23 CCR§2646 ❑ b.STATISTICAL PER 23 CCR§2646.1 M24. ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)PER 23 CCR§2645 TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS M25. ❑ 5.INTEGRITY TESTING PER 23 CCR§2643.1 TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): M26. M27. ❑ 6.VISUAL MONITORING DONE: ❑ a.DAILY ❑ b.WEEKLY(Requires agency approval) ❑ 99.OTHER(Specify): M28. V. PIPE MONITORING MM07TORING IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) M30. Ly'I.CONTINUOUS ELECTRONIC MONITORING OF PIPING SUMP(S)/TRENCH(ES)AND OTHER SECONDARY CONTAINMENT SECONDARY CONTAINMENT IS: a.DRY El b.LIQUID FILLED ❑ c.UNDER PRESSURE El d.UNDER VACUUM M31. PANEL MANUFACTURER: M32. MODEL# S® M33. LEAK SENSOR MANUFACTURER. V 'Ae M34. MODEL#(S): LP wee> M35. WILL A PIPING LEAK ALARM TRIGGER AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN? ' YES ❑ b.NO M36. WILL FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? 9KYES ❑ b.NO MIT ❑ 2.MECI-[ANICAL 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 MLLD MANUFACTURER(s): M"- MODEL#(S): M39. ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS ELLD MANUFACTURER: M40 MODEL#: M41. PROGRAMMED LINE INTEGRITY TESTS: ❑ a.MINIMUM MONTHLY 0.2 g.p.h. ❑ b.MINIMUM ANNUAL 0.1 g.p.h. M42. WILL ELLD DETECTION OF A PIPING LEAK TRIGGER AUTOMATIC PUMP SHUTDOWN? ❑ a.YES ❑ b.NO M43. WILL ELLD FAILURE/DISCONNECTION TRIGGER AUTOMATIC PUMP SHUTDOWN? ❑ a.YES ❑ b.NO M44. ❑ 4.INTEGRITY TESTING TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(Specify) M45. M46. ❑ S.VLSUAL MONITORING DONE: ❑ a.DAILY ❑ b.WEEKLY* ❑ C.MIN.MONTHLY&EACH TIME SYSTEM OPERATED** M4T *Requires agency approval **Allowed for monitoring of unburied emergency generator fuel piping only per HSC§25281.S(b)(3) ❑ 6.PIPING IS SUCTION PIPING MEETING ALL REQUIREMENTS FOR EXEMPTION FROM MONITORING PER 23 CCR§2636(a)(3) ❑ 7.NO PRODUCT OR REMOTE FILL PIPING IS CONNECTED TO THE UST(s) ❑ 99.OTHER(Specify) M48. UN-022A-1/5 www.unidoes.org Rev. 10/14/03