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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN-Eale 1 of Z TYPE OF ACTION ® 1.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): I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) 1. BUSINESS NAME(Same as Facility Name or DBA) 3. Chevron Station#201761 BUSINESS SITE ADDRESS 1103 S. Main St. 103. CITY Manteca,CA 95337 104 II. EQUIPMENT TESTING AND PREVENTIVEMAINTENANCE 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 a ui ment manufacturers'instructions,or annually,whichever is more frequent.Such work must be performed by qualified personnel.[23 CCR§2632,2634,2638,26411 EQUIPMENT IS SERVICED ® 1.ANNUALLY ❑ 99.OTHERS cif 4943. MONITORING E Q (Specify): 4 .36. III., MONITORING LOCATIONS< ® L NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN ❑ 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED [23 CCR§2632,26341 490-4. IV. TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) (Checkthat 'I' ® 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) 4905. WITH AUDIBLE AND VISUAL ALARMS.[23 CCR§2632,26341 SECONDARY CONTAINMENT IS: ® a.DRY [I b.LIQUID FILLED ❑ c.PRESSURIZED ❑ d.UNDER VACUUM 4906. PANEL MANUFACTURER: Veeder-Root 490-7. MODEL#: TLS-350 49M LEAK SENSOR MANUFACTURER: Veeder-Root 990- MODEL#(S): Liquid Sensor Series 794380-409 490-10. E] 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 DAILY/NIGHTLY U c.WEFREY 490-16. ❑ d.MONTHLY ❑ e.OTHER(Specify): 490-17. PROGRAMMED TESTS: ❑ a.0.I h. ❑ b.0.2 h. ❑ c.OTHERS cif ago-18. g.p.h. _ g.p.h. (Specify): a90-19. F13.MONTHLY STATISTICAL INVENTORY RECONCILIATION[23 CCR§2646.11 aso 220.- ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)[23 CCR§26451 TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS ago 21. _ __a90-zz_ El5.TANK INTEGRITY TESTING PER[23 CCR§2643.11 490-23. ago-24. TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): 490-25. El99.OTHER(Specify): 490-26. ago-27. V. PIPE MONITORING IS PERFORMED USING THE FOLLO GOD(S) that apply ® 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. §2636] PANEL MANUFACTURER:Veeder-Root 490-30. MODEL#: TLS-350 490-31. LEAK SENSOR MANUFACTURER: Veeder-Root 490-32. MODEL#(S): Liquid Sensor Series 794380-208 490-33. PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. ® 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): 490 37. MODEL#(S): 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):Veeder-Root 49040 MODEL#(S):PLLD Series 848480-003 490-41. 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 490-43. ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ® a.YES ❑ b.NO 490-44. ❑ 4.PIPE INTEGRITY TESTING. 490-45. TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(Specify) 4 490-46, ❑ 5.VISUAL PIPE MONITORING. 49048. FREQUENCY: ❑ a.DAILY ❑ b.WEEKLY ❑ C.MIN.MONTHLY&EACH TIME SYSTEM OPERATED* 49049. Allowed for monitorinitof unburied emergency generator to Qin_9nly_per HSC 25§ 281.5(6()..-_. ❑ 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.