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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN-(Page 1 of 2) TYPE OF ACTION ❑ I.NEW PLAN ® 2.CHANGE OF INFORMATION 490-1. PLAN TYPE ❑ 1.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. 490-2. (Check one item only) ® 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): Gas Station USTS I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) 1. BUSINESS NAME(Same as Facility Name or DBA) 3 CRLLC/76#5446 BUSINESS SITE ADDRESS 1403 COUNTRY CLUB BLVD 103' CITY STOCKTON 104. II. EQUIPMENTTESTING 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 annual( ,whichever is more frequent.Such work must be performed by qualified personnel.[23 CCR§2632,2634,2639,26411 EQUIPMENT IS SERVICED ® 1.ANNUALLY ❑ 99.OTHER490-3. MONITORING E Q (Specify): 490-36. IH. MONITORING LOCATIONS ❑ 1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN ® 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED [23 CCR§2632,2634] 4904. IV. TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) 'aleck all 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) 490-5. WITH AUDIBLE AND VISUAL ALARMS.[23 CCR§2632,26341 SECONDARY CONTAINMENT IS: ® a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED ❑ d.UNDER VACUUM 490.6. PANEL MANUFACTURER: Veeder Root 490-7' MODEL#: TLS-350 W/ISD 496-8. LEAK SENSOR_MANUFACTURER: Veeder Root 490-9' MODEL#(S): 302 490-10. ❑ 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-I6. ❑ d.MONTHLY ❑ e.OTHER(Specify): 490-17. PROGRAMMED TESTS: ❑ a.0.1 h. ❑ b.0.2 h. ❑ c.OTHERS if ago-18. g.p.h. g•P• (Specify): a90-l9. ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION[23 CCR§2646.11 490-20. El4.WEEKLY MANUAL TANK GAUGING(MTG)[23 CCR§26451 TESTING PERIOD: [:] a.36 HOURS [:1b.60 HOURS 19121. _ 190-22. ❑ 5.TANK INTEGRITY TESTING PER[23 CCR§2643.q 490-23. TEST FREQUENCY: ® a.ANNUALLY E] b.BIENNIALLY ❑ c.OTHERif 490-24. (SPeC�Y)� a90-zs. -- 490-26. ❑ 99.OTHER(Specify): 490-27. V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) '1 atakll) ® 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE&VISUAL ALARMS. 490.28. [23 CCR SECONDARY CONTAINMENT IS: ® a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED ❑ d.UNDER VACUUM 490-29. §26361 PANEL MANUFACTURER:Veeder Root 490-30. MODEL#: TLS-350 W/ISD 490-31. LEAK SENSOR MANUFACTURER: Veeder Root 490-32. MODEL#(S): 208 490-33. PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. in a.YES ❑ b.NO 490-34. FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ® a.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 490-36. PRODUCT FLOW WHEN A LEAK IS DETECTED.[23 CCR§26361 MLLD MANUFACTURER(S): Vapor'1 e S S 491-37. MODEL#(S): 9 9 LD2 0 0 0 490-38. ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS.[23 CCR§26361 490.39. ELLD MANUFACTURER(S): 49040. MODEL#(S): 490.41. PROGRAMMED IN LINE LEAK TEST: ❑ a.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 49143. ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. [I a.YES ❑ b.NO 49144. ❑ 4.PIPE INTEGRITY TESTING. 49045. TEST FREQUENCY: a.ANNUALLY C1b.EVERY 3 YEARS E] c.OTHER(Specify) 490449046. ❑ 5.VISUAL PIPE MONITORING, 49048. FREQUENCY: ❑ a.DAILY ❑ b.WEEKLY c'MIN.MONTHLY&EACH TIME SYSTEM OPERATED* 49049. Allowed for 'ngof unburied emergency generator fuel i in onl HSC L25281.5(b 3 ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA.[23 CCR§2636(.)(3)1 490-50. ❑ 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM. 490-51. 490-52. ❑ 99.OTHER(Specify) 490-53. UPCF UST-13(12/2007)-1/3 www.unidocs.org