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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 ❑ 1.NEW PLAN ❑ 2.CHANGE OF INFORMATION M°I. PLAN TYPE MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. M01 (Check one item only) ❑ THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): L 'FACILITY INFORMATION FACILITY ID#(Agency Use Only) ✓ic '7 46 1 IT FACILITY NAME �r -7j, N103 FACILITY SITE ADDRESS �� M04. CITY 4'/�N e� los. 16 �a � k%a + w H. EQUIPMENT 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 %106. accordance with the equipment manufacturers'instructions,or annual1 whichever is more frequent. Such work must be performed by qualified personnel. MONITORING EQUIPMENT IS SERVICED 61 '.ANNUALLY ❑ 99.OTHER(Specify): D107. III. MONITORING 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 MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S):(Check all that apply) MIO ❑ I.CONTINUOUS ELECTRONIC MONITORING QF TANK ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) NT SECONDARY CONTAINMEIS: a.DRY ❑ b.LIQUID FILLED ❑ c.UNDER PRESSURE ❑ d.UNDER VACUUM MI1. PANEL MANUFACTURER: We- M12. MODEL#: 11113. LEAK SENSOR MANUFACTURER: M14. MODEL#(S): M15. ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANKS) PANEL MANUFACTURER: M16. MODEL#: N117. IN-TANK PROBE MANUFACTURER: M" MODEL#(S): N119 LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY hLO. ❑ d.MONTHLY ❑ e.OTHER(Specify): M21. PROGRAMMED TESTS: ❑ a.0.1 g.p.h. ❑ b.0.2 g.p.h. ❑ c.OTHER(Specify): n122. 6123. ❑ 3.INVENTORY RECONCILIATION ❑ a.MANUAL PER 23 CCR§2646 ❑ b.STATISTICAL PER 23.CCR§2646.1 6124 ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)PER 23 CCR§2645 TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS 61215. ❑ 5.INTEGRITY TESTING PER 23 CCR§2643.1 TEST FREQUENCY: ❑�.ANNUALLY El b.BIENNIALLY [:] c.OTHER(Specify): M26. M2z El &VISUAL MONITORING DONE: m a.DAILY ❑ b.WEEKLY(Requires agency approval) ❑ 99.OTHER(Specify): 6f?8. V. PIPE MONITORING VITORING IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) 61[30 CONTINUOUS ELECTRONIC MONITORING PIPING SUMP(S)/fRENCH(ES)AND OTHER SECONDARY CONTAINMENT NT SECONDARY CONTAINMEIS: i,Q a.DRY El b.LIQUID FILLED ❑ a UNDER PRESSURE ❑ d.UNDER VACUUM PANEL MANUFACTURER: V e. T'-,s 6132. MODEL#: M33 LEAK SENSOR MANUFACTURER: bt3a. MODEL#(S): N05 WILLA PIPING LEAK ALARM TRIGGER AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN? ❑ a.YES ❑ b.NO bub. WILL FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? ❑ a.YES ❑ b.NO M37. S/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 MLLD MANUFACTURER(s): Mas. MODEL#(S): bug. ❑ 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. 614'- WILL ELLD DETECTION OF A PIPING LEAK TRIGGER AUTOMATIC PUMP SHUTDOWN? ❑ a.YES ❑ b.NO 11143. WILL ELLD FAILURE/DISCONNECTION TRIGGER AUTOMATIC PUMP SHUTDOWN? ❑ a.YES ❑ b.NO bt44 ❑ 4.INTEGRITY TESTING TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(Specify) M45. M46 ❑ 5.VISUAL MONITORING DONE: R1 a.DAILY ❑ b.WEEKLY* ❑ C.MIN.MONTHLY&EACH TIME SYSTEM OPERATED** M47. *Requires agency approval **Allowed for monitoring of unburied emergency generator fuel piping only per HSC§25281.5(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.unidocs.org Rev.10/14/03