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UNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANK <br /> MONITORING PLAN-(Page 1 of 2) <br /> TYPE OF ACTION ❑1.NEW PLAN 2.CHANGE OF INFORMATION 490-1 <br /> PLAN TYPE 1.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. 490-2 <br /> (Check one item only) ❑ 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S)- <br /> T. FACILITY INFORMATION <br /> FACILITY ID#(Agency Use Only) - - <br /> BUSINESS NAME(Same as FACILITY NAME) 1- 3. <br /> BUSINESS SITE ADDRESS 2-SCD 103 CITY S IN <br /> II.EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE <br /> Testing,preventive maintenance,and calibration of monitoring equipment(e.g.,sensors,probes,line leak detectors,etc.)must be performed at the frequency <br /> specified by the equipment manufacturers'instructions,or annually,whichever is more frequent,and that such work must be performed by qualified personnel. <br /> 23 CCR 2632,2634,2638,2641 <br /> 490-30 <br /> MONITORING EQUIPMENT IS SERVICED 1.ANNUALLY ❑ 99.OTHER(Specify): 490-3b <br /> III"MONITORING LOCATIONS <br /> ❑1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. W2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, <br /> 2634)4904 <br /> IV.TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): <br /> [�1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT 490-5 <br /> VAULT(S)WITH AUDIBLE AND VISUAL ALARMS. (23 CCR§2632,2634) <br /> SECONDARY CONTAINMENT IS: a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED ❑d.UNDER VACUUM 490-6 <br /> ---------------------------------- ------------------------------------------- -------------------------------------------------------- <br /> _ PANEL MANUFACTURER: 490 7. MODEL#: 490-8 <br /> - 1 eeAl�� ------------ - T -��Q---------- <br /> LEAK SENSOR MANUFACTURER: L r 490 9 MODEL#(S):��' 0901° <br /> ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).(23 CCR§2643) 490-11 <br /> PANEL MANUFACTURER: 490-12. MODEL#: 490-13 <br /> -------- - -- ------------------------- ------ --------------------------------- <br /> IN-TANK PROBE_MANUFACTURER: ago-la. _MODE_L#_(S):_ __ 490-15 <br /> __ <br /> -LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY 490-16 <br /> d.MONTHLY ❑ e.OTHERS cif 490-17 <br /> --------------------------------------------------------------- <br /> PROGRAMMED TESTS: ❑ a.0.1 h. ❑ b.0.2 h. ❑ c.OTHERS 1f 49019 <br /> g.p.h. g.p.h. (Specify): 49019 <br /> ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 49020 <br /> ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§2645). TESTING PERIOD: E] a.36 HOURS [Ib.60 HOURS 4 0-22 <br /> ❑ 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 490-23 <br /> TEST FREQUENCY: Ela.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): 4w-z5 <br /> 490-26 <br /> ❑99.OTHER (Specify): 490.27 <br /> V.PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) <br /> IQ 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 490-28 <br /> VISUAL ALARMS. (23 CCR§2636) <br /> SECONDARY CONTAINMENT IS:Ma.DRY ❑b.LIQUID FILLED ❑c.PRESSURIZED ❑d.UNDER VACUUM 490-29 <br /> -- - <br /> 490-31 <br /> PANEL MANUFACTURER:------_- _�r -- --- "'o i MODEL#: <br /> _ <br /> LEAK SENSOR MANUFACTURER: 09032 MODEL#(S): Q 490-33 <br /> u0 0 ,�,o r-los2 ---------------------------------- ----�5 ---.�,�z_ <br /> PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. 04 a.YES ❑b.NO 490-34 <br /> FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. tea.YES ❑b.NO 490-35 <br /> MECHANICAL LINE LEAK DETECTOR(MLLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS AND RESTRICTS OR SHUTS OFF <br /> PRODUCT FLOW WHEN A LEAK IS DETECTED 23 CCR 2636 _ 490-36 <br /> --- - ------ DETECTED --------- ------- ------ - -- <br /> MLLD MANUFACTURER(S): MODEL#(S): 49038 <br /> ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAY ROUTINELY PERFORMS 3.0 g.p. .LEAK TESTS (23 CCR§2636) 490-39 <br /> ------- ----- --------------------------------------------0o. MODEL#(S):-- - ----------------------------------------- <br /> a90 - 09001 <br /> _ ELLD MANUFACTURER(S) _ _ _ _ ___-___---_-_____ _ <br /> PROGRAMMED IN LINE LEAK TEST_ ❑ 1.MINIMUM MONTHLY 0.2 g.p.h. ❑ 2.MINIMUM ANNUAL 0.1 g.p.h. 490-42 <br /> ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 49043 <br /> ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 49044 <br /> ❑ 4.PIPE INTEGRITY TESTING 49045 <br /> TEST FREQUENCY ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(Specify) 490-46 490-47 <br /> ❑ 5.VISUAL PIPE MONITORING. 490-48 <br /> FREQUENCY ❑ a.DAILY ❑ b.WEEKLY ❑c.MIN.MONTHLY&EACH TIME SYSTEM OPERATED* 490-49 <br /> "Allowed for monitoring of unburied emergency enerator fuel pipinp,only per HSC§25281.5(bX3) <br /> ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA[23 CCR§2636(ax3)]. 490-50 <br /> ❑ 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM <br /> 490-51 <br /> 52 <br /> ❑ 99.OTHER(Specify) 490 s3 <br /> UPCF UST-D(12/2007)1/4 <br />