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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN - (Page I of 2) TYPE OF ACTION M 1. NEW PLAN ® 2. CHANGE OF INFORMATION 490.1 PLAN TYPE ® 1. MONITORING IS IDENTICAL FOR ALL USTS AT THIS FACILITY. 490-2 )eck one item only) ❑ 2. THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM($)• I. FACILITY INFORMATION FACILITY ID # (Agency Use Only) BUSINESS NAME (Same as FACILITY NAME) Yosemite 76 #255417 ' BUSINESS SITE ADDRESS 1700 East Yosemite Avenue 103' CITY Manteca 104. II. EQUIPMENT TESTING: AND PREVENTIVE MAINTENANCE. Testing, preventive maintenance, and calibration of monitoring equipment (e.g., sensors, probes, line leak detectors, etc.) must be performed at the frequency specified by the equipment manufacturers' instructions, or annually, whichever is more frequent, and that such work must be performed by qualified personnel. 23 CCR §2632, 2634L2638_2641--- -_ 99. OTHER 490-36 MONITORING EQUIPMENT IS SERVICED ® E ANNUALLY ❑ (Specify): III. MONITORING LOCATIONS . ® I. NEW SITE PLOT PLANAIAP SUBMITTED WITH THIS PLAN. 112. SITE PLOT PLAN/MAP PREVIOUSLY SUBiiI[TI-ED. (23 CCR §2632, 2634)490-4 IV. TANK MONITORING IS PERFORMED USING THE FOLLOWING ETHOD(S): ® 1. CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR (INTERSTITIAL) SPACE(S) OR SECONDARY CONTAINMENT 490-5 VAULT(S) WITH AUDIBLE AND VISUAL ALARMS. (23 CCR §2632,2634) SECONDARY CONTAINMENT IS: ® a. DRY El b. LIQUID FILLED El c. PRESSURIZED [Id. UNDER VACUUM ------ 49-36 Veeder Roota9a7-1 MODEL #: TLS -350 PANEL MANUFACTURER:-- - _- __--------- LEAK SENSOR MANUFACTURER: Veeder Root 490-9. MODEL #(S): 794380-420 490-10 2. AUTOMATIC TANK GAUGING (ATG) SYSTEM USED TO NIONITOR SINGLE WALL TANK($). (23 CCR §2643) 490.11 PANEL MANUFACTURER: 490 12' MODEL #: 490-13 fN-TANK PROBE MANUFACTURER: 490.14. MODEL #(S): _._._._------•-------••- 490 -Is _--------------------- ____-..-_____------_..__-----•---------------- -------- - ------- ----------- ---------------_ LEAK TEST FREQUENCY: Ela. CONTINUOUS [Ib. DAILY/NIGHTLY ❑ c. WEEKLY 490.16 ❑ d. MONTHLY ❑ e. OTHER (Specify): 49x17 PROGRAMMED TESTS: Ela. 0.1 g.p.h. El b. 0.2 g.p.h. ❑ c. OTHER (Specify): 490-18 490.19 3. MONTHLY STATISTICAL INVENTORY RECONCILIATION (23 CCR §2646.1): 440. Lj 4. WEEKLY MANUAL TANK GAUGING (NITG) (23 CCR §2645). TESTING PERIOD: ❑ a. 36 HOURS ❑ b. 60 HOURS 490.21 490-22 F15. TANK INTEGRITY TESTING (23 CCR §2643.1): 490-23 TEST FREQUENCY: [3a. ANNUALLY [Ib. BIENNIALLY [1 (Specify): c. OTHER490-24 490-zs 490-26 ❑ 99. OTHER (Specify): 490-27 V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD($) (Check all that apply) ® 1. CONTINUOUS MONITORING OF PIPE/ PIPING SUMP(S) AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 490-28 VISUAL ALARMS. (23 CCR §2636) 49-29 SECONDARY CONTAINMENT IS: ®a. DRY ❑b. LIQUID FILLED [-1c. PRESSURIZED ❑d. UNDER VACUUM r-------- 490-3° I MODEL #: TLS_35O PANEL MANUFACTURER: Veeder Root_- - 44x31 -- - -_- ------'---'---------- - - 490-32 t LEAK SENSOR MANUFACTURER: Veeder Root 1 MODEL #(S): 794380-208 _ ODE --___-.-__•-..-_ - 490-33 ---_ _ _-_--._- -- - PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP (i.e., TURBINE) SHUTDOWN. ® a. YES ❑ b. NO 49°'34 FAILURE/DISCONNECTION OF THEMONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ® a. YES ❑ b. NO 490-35 2. MECHANICAL LINE LEAK DETECTOR (1MLLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS AND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK IS DETECTEDX23 CCR I263) 490.36 MLLD MANUFACTURER(S): Va orlesS 440-37 MODEL #(S): LD2000 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) 490 -00 I MODEL #(S): --------- - 490-41 --2 ---------- _ _-- - _- - --- - - - -- - - - - - - _- --_ _- - - PROGRAMMED M LINE LEAK TEST: ❑ 1. MINIMUM MONTHLY 0.2 h. ❑ 2. MINIMUM ANNUAL 0.1 g.p.h. gP 49-42 ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a. YES El b. NO 49°43 ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. [Ia. YES 13b. NO 49044 4. PIPE INTEGRITY TESTING 49045 TEST FREQUENCY ❑ a. ANNUALLY ® b. EVERY 3 YEARS ❑ c. OTHER (Specify) 49046490.47 5. VISUAL PIPE NIONITORING. 490-48 FREQUENCY ❑ a. DAILY ❑ b. WEEKLY ❑ C. MIN. MONTHLY & EACH TIME SYSTEM OPERATED` 49049 • Allowed for -itoring, of unburied emergency enerator fuel piping oaiy per HSC §25281.5(b)(3) r] - 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 TILE TANK SYSTEM "490-51 440-52 ❑ 49. OT[IER (Specify) ago -53 UPCF UST -D (112007)