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0 UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN- (Pae I of 2) TYPE OF ACTION ❑ 1.NEW PLAN ❑ 2.CHANGE OF INFORMATION 490-1. PLAN TYPE Erl.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. 490-2. (Check one idem only) ❑ 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) 1' BUSINESS NAME(Same as Racili Name or DBA) 3. o BUSINESS SITE ADDS loa. CITY c l� r i J f 0 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 theequipment_manufacturers'instructions,or annually,whichever is ore frequent. Such work must be performed by qualified personnel.[23 CCR§2632 2634.2638,26at[ MONITORING EQUIPMENT IS SERVICED I.ANNUALLY El99.OTHERcif 490-3a (Spe y): 490-3b. IIL.MONITORING LOCATIONS ❑ 1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN ❑ 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED [23 CCR§2632,26341 4904 IV. TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) (at hck`ll t 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) a90-s. WITH AUDIBLE AND VISUAL ALARMS.[23 CCR§2632.26341 / SECONDARY CONTAINMENT IS: a.DRY [Ib.LIQUID FILLED EK PRESSURIZED ❑ d.UNDER VACUUM 490-6 PANEL MANUFACTURER: o j f q 7LJ 490- 7, MODEL#: ! !0 490-8. LEAK SENSOR MANUFACTURER: 490-9- MODEL#(S): ,_ 490-10 ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).[23 CCR§26431 490-11. PANEL MANUFACTURER: 490-12. MODEL#: 490-13. IN-TANK PROBE MANUFACTURER: 490-14. MODEL#(S): 490-15. LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY 490-16. ❑ d.MONTHLY ❑ e.OTHER490-t7. (Specify): PROGRAMMED TESTS: ❑ a.0.1 h. ❑ b.0.2 h. c.OTHERS cif 490 18. g-p -----.__----g=p----- -®-----.._.. Pe Y..)_:_. ago-lv. El3.MONTHLY STATISTICAL INVENTORY RECONCILIATION 123 CCR§2646.11 490-M 4.WEEKLY MANUAL TANK GAUGING MTG 23 CCR§2645 TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS 422. ❑ ( )[ I 49490- ..----------------- ---------------------------------------- -----.....___._._�..----...__-------------------._.... ❑ 5.TANK INTEGRITY TESTING PER[23 CCR§zr>a3.11 ago-z3. TEST FRE QUENCY: El a. b.BIENNIALLY Ela. c.OTHER_(.S y�' 490-2 cif 42 --._� _490-25,490-24 ,_._....... - a HI-26. ❑ 99.OTHER(Specify): 490-27. V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) (check all that apply) 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE&VISUAL ALARMS. 490-28. 123 CCR SECONDARY CONTAINMENT IS: ❑ a.DRY ❑ b.LIQUID FILLED [mac.PRESSURIZED ❑ d.UNDER VACUUM 490-22 §26361 PANEL MANUFACTURER: <E'g t, �-J.- 16 (q/ 490-30. MODEL#: ,?o 400-31. LEAK SENSOR MANUFACTURER: 6P 490-32 MODEL#(S): 490-33. PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. ET a.YES ❑ b.NO 490-34. FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. 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 49036, PRODUCT FLOW WHEN A LEAK IS DETECTED.[23 CCR§26361 490-37. MODEL#S 490-38. MLLD MANUFACTURER(S): �)__ ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS.123 CCR§26361 490-39. ELLD MANUFACTURER(S): 49040. MODEL#(S): 49041. PROGRAMMED IN LINE LEAK TEST: F1a.MINIMUM MONTHLY 0.2 g.p.h. ❑ b.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. C3 a.YES [:] b.NO 490-44. -----.._.-._._....___-__.._.._._.._...- - ---..--_...---- - ---- ---- --- ------- ❑ 4.PIPE INTEGRITY TESTING. 49045, TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHERS cif 49046. ❑ 5.VISUAL PIPE MONITORING. 49048 FREQUENCY: ❑ a.DAILY ❑ b.WEEKLY ❑ C.MIN.MONTHLY&EACH TIME SYSTEM OPERATED" 49049. _--_"Allowed for mom torin-of mburied_emergencv generator fuel pipingonlvper HSC?t25281-5(b)(3)_F1 6.6.SUCTION PIPING MEETS EXEMPTION CRITERIA.123 CCR§2636(a)(3)1 490-50 ElT NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,C14APTER 6.7 IS CONNECTED TO THE TANK SYSTEM. 490-5 1 ❑ 99.OTHER(Specify) 490-53. UPCF UST-D(12/2007)-1/4 www.unidoes.org