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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN-(Page 1 of 2) �AR TYPE OF ACTION [711.NEW PLAN 2.CHANGE OF INFORMATION 0 490-1 PLAN TYPE ❑ I.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. 3 SitCC ago 2 4�"J � (Check one item only) 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM( .T' ' TG1RI1?Il� ,Y FACILITY ID#(Agency Use Only) - 3 BUSINESS NAME(Same as FACILITY NAME) S�� 51t is T�Q df t 3 BUSINESS SITE ADDRESS ^7o00 µ►'CL C'A0&- D 103. CITY `L camr 104 9-ZQUWNE+ ' (P"=+��+�V)TNE � m V�� 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 annually,whichever is more frequent,and that such work must be performed by qualified personnel. 23 CCR§L632,2634,2638,264!) EQUIPMENT IS SERVICED 1.ANNUALLY ❑ 99.OTHERS ci 490-38 MONITORING E Q ( 178 �')� 490-36 -MOM WORINGCO ' JONS ; i.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. F1 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 634)49o.4 01 XONEPORMG11S ERP ED 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT 490-5 VAULT(S)WITH AUDIBLE AND VISUAL ALARMS. (23 CCR§2632,2634) SECONDARY CONTAINMENT IS_:____ a.DRY F] b.LIQUID FILLED E] c.PRESSURIZED ❑d.UNDER VACUUM 490-6 --- - - - - - - --- - - - - -- ----- ---- 490-7. ----- ---- -- - - - --8 PANEL MANUFACTURER: V CR 19 . ; MODEL#: 'TL9 3 49x8 LEAK SENSOR MANUFACTURER: V A 1 MODEL#(S: 4041 490-10 ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).(23 CCR§2643) 490-11 PANEL MANUFACTURER:_ _ 490-12. MODEL##: 490-13 IN-TANK PROBE MANUFACTURER--------------- --- 490-14. MODEL#---- ------------------------------aso-is ---------I----------PROB -----------------------------------------------------------------------0---------------------------------------------------------------- LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY 490-16 ❑ d.MONTHLY ❑ e.OTHER(Specify): 490-17 ---------- ----------------- ---- ------ ----- ---------- -- ----- ---------------- ------ ---- - ---- 49x1818 PROGRAMMED TESTS: ❑ a.0.1 g.p.h. ❑ b.0.2 g.p.h. ❑ c.OTHER(Specify): 490-19 ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 490-20 ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§2645). TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS 490-21 490-zz ❑ 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 490-23 490-24 TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): 49x25 490-26 ❑99.OTHER (Specify): 490-27 ,.. 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 490-28 VISUAL ALARMS. (23 CCR§2636) SECONDARY CONTAINMENT IS:Nfa.DRY ❑b.LIQUID FILLED ❑c.PRESSURIZED ❑d.UNDER VACUUM 490-29 ------------------------------------ - - - - ---- - ------------ - s---- - ------ -- ------------ PANEL MANUFACTURER: V Ego go- 490-30 I MODEL#: `CL43 S SO 490-31 -------------------- ------------------- ------------------------------------- LEAK SENSOR MANUFACTURER: V S" 490-32 MODEL#(S): 2D 490-33 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. C,a.YES ❑b.NO 490-34 FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. Ita.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 PRODUCT FLOW WHEN A LEAK IS DETECTED(23 CCR�2636Z__ 490-36 --------------------------------------- -------- ------------------------------------------------------------- MLLD MANUFACTURER(S): 490-37 MODEL#(S): 490-38 ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS (23 CCR§2636) 490-39 ELLD 411 _ _ _ 49°40 MODEL#_(S): 49041 PROGRAMMED IN LINE LEAK TEST: ❑ 1.MINIMUM MONTHLY 0.2 g.p.h. ❑ 2.MINIMUM ANNUAL 0.1 g.p.h. 490-42 ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 490-43 ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 4904A ❑ 4.PIPE INTEGRITY TESTING 49045 TEST FREQUENCY ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(Specify) 4904649047 ❑ 5.VISUAL PIPE MONITORING. 490-48 FREQUENCY ❑ a.DAILY ❑ b.WEEKLY ❑C.MIN.MONTHLY&EACH TIME SYSTEM OPERATED* 490-49 "Allowed for monitoring of unburied emffgmcy gmffalor fuel piping only per HSC§25281.5(b)(3) 6.SUCTION PIPING MEETS EXEMPTION CRITERIA]23 CCR§2636(a)(3)]. 490-50 ❑ T NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 ISTHE TANK SYSTEM 490-51 ❑ 490-52 99.OTHER(Specify) 490-53 MAR 2 6 2015 UPCF UST-D(12/2007)1/4 ENVIRONMENTAL HEALTH PERMIT/SERVICES _ J