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.-, ,A DEGRO MRAGE TANK MONITORING PL - PAGE 1 TYPE OF ACTION] 1. NEW PLAN ❑ 2. CHANGE OF 04FORMATION M01 PLAN TYPE ❑ MONITORING IS IDENTICAL FOR ALL USTS AT THIS FACILITY. M02. (Check one item only) ❑ THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEMS) I. FACffiffY IWORMATION FACILITY ID # (Agency Use Only) BUSINESS NAME (Same as FACILITY NAME) LVy $ V F(� M03, BUSINESS SITE ADDRESS -2 . LAJ 2/I j Mao CITY C -4 Mos. H. EQLqPMENT ITSMG AND PREVENTWE MMNTENANCIE State law requires that testing, preventive maintenance, and calibration of monitoring equipment (e.g., sensors, probes, line leak detectors, etc.) be performed at the frequency specified by the equipment manufacturers' instructions, or annually, whichever is more firequent, and that such work must be performed by qualified personnel. MONITORING EQUIPMENT IS SERVICED 191. ANNUALLY MOs. ❑ 99. OTHER (Specify): Mm DL MONITORMG LOCATIONS* This monitoring plan must include a Site Plan showing the general tank and piping layouts and the locationswhere itoring is performed (i.e., location of each tensor, line leak detector, monitoring system control panel, etc.). If you already have a diagram (e.g., current UST Monituring Site Pian from a Monitoring System Certification form H Materials Bust Plan etc. which shows all required inf inc! it with this an IV. TANK MONffOPING MONITORING IS PERFORMED USING THE FOLLOWING HOD(S): (Check all that y) M10. I . CONTINUOUS ELECTRONIC MONITORING OF TANK ANNULAR MAL) SPACE(S) OR SECONDARY CONTAINMENT VAULT(S) SECONDARY CONTAINMENT IS:^ V a. DRY ❑ b. LIQUID FILLED ❑ c. PRESSURIZED ❑ d. VACUUM M11 PANEL MANUFACTURER: � w M12. MODEL #: �- i P®f Mr3. LEAK SENSOR MANUFACTURER: P-4 liq C. Mt4. MODEL #(S): N 1 (1 ":7 M15. ❑ 2. AUTOMATIC TANK GAUGING (ATG) SYSTEM USED TO MONITOR SINGLE WALL TANK(S) PANEL MANUFACTURER: M16. MODEL 9: M17. 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. 0.1 g.p.h. ❑ b. 0.2 g.p.h. ❑ c. OTHER (Specify). M22. M23. ❑ 3. INVENTORY RECONCILIATION ❑ a. MANUAL PER 23 CCR §2646 ❑ b. STATISTICAL PER 23 CCR §2646.1 "tit. ❑ 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 ej TEST FREQUENCY: ❑ b. BIENNIALLY ❑ c. OTHER (Specify): M26. M27. ❑ 6.VISUAL MONITORING: r7a. DAILY ❑ b. WEEKLY ❑ 99. OTHER (Specify): M29. V. PIPE MONMIMG MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply) M30. 10 1. CONTINUOUS MONITORING OF PIPING SUMPS H(ES) AND OTHER SECONDARY CONTAINMENT SECONDARY CONTAINMENT IS: DRY ❑ b. LIQUID FILLED ❑ c. PRESSURIZED ❑ d. VACUUM M31. PANEL MANUFACTURER: Y� (,g�`i� '.M32- MODEL #: M33. LEAK SENSOR MANUFACTURER: V5 M34. MODEL #(S): 'TS 4A Ll WILL A PIPING LEAK ALARM TRIGGER AI1T6MAi7iC PUMP (i.e., TURBINE) SHUTDOWN? ❑ a. YES ❑ b. NO M36 - WILL FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGER AUTOMATIC PUMPS WN? ❑ a. YES ❑ b_ NO M37. fR 2. MECHANICAL LINE LEAK DETECTOR (MLLD) THAT ROUTINELY PERFORM5�3.0 g.ph LEAK TESTS AND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK IS DETF-CTE Ok `��! MLLD MANUFACTURER(s): t ` Mas. MODEL #(S): � U M39. 3. ELECTRONIC LINE LEAK DETIECTOR (AL.LD) THAT ROUTINELY PERFORMS 3.0 g p.h. LEAK TESTS \ ELLD MANUFACTURER(s) ` M40. MODEL #(S): M41. PROGRAMMED IN LINE TESTINt ❑ a. MINIMUM MONTHLY 0.2 g.p.h. ❑ b. MINIMUM ANNUAL 0.1 g.p.K 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. O (Spcify) M45. .05 M46. . 05. VISUAL MONITORING: ❑ a. DAILY ❑ b. WEEKLY ❑ C. MIN. MONTHLY dr EACH TIME SYSTEM OPERATED* M47. • Aftwed ra mm iitaing of unbuded ffid Mpg �y t" HSC §252SI.5rox3) ❑ 6. SUCTION PIPING MEETS E PTION C APER 23 CCR §2636(a�3} ❑ ?. NO PRODUCT OR REMOTE FILL PIPING IS CONNECTED TO THE UST(s) ❑ 99. OTHER (Specify) Mos. hwfwrc-d (9/24/04) -1/4