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UNIFIED PROGRAM GONSOLTDATED FORM
<br /> 3
<br /> UNDERGROUND S'T'ORAGE TANK
<br /> NIT -(Pae 1 of )
<br /> TYPE OF ACTION 1.NEW PLAN El 2,CHANGE OF INFORMATION
<br /> _ �
<br /> PLAN TYft 1.MONITORING IS IDENTICAL FOR ALL USTs AT TIES FACILITY.
<br /> (Check one Item only) ❑ 1TH 1S PLAN COVERS ONLY THE FOLLOW 1NO UST SYS ):
<br /> FACiLrrY ID#(Agency Use Only)
<br /> BUS IN NAME(Same asracll ryNameorDBf1J
<br /> Chevron Statipn#201761 W
<br /> R I i 00s SITE ADDRESS 1103 S. Main St.,... 103. CITY Manteca,CA 96337 1044.
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<br /> Testing,preventive maintenance,and calibration of monitoring Nuipmem(e.g.,sensors,prof,line Ink detectors,etc.)must be performed at aro$3:quens-y speciFied
<br /> b the octuapment menu 'instructions,or annuatty,^whichever is more frequent.Such work,mud bcTT farmed by qualified Personnel.I23 CCR 42634 2634.2833_ane+L
<br /> MONITORIN(:POU1PMENT IS SERVICED ® 1.ANNUALLY ❑ 99.OTHER(Spcc)fy): apse
<br /> .• . ..•: ..:�..:.:.... :.� ..:::. ::. .: .. . . .:: '::�.�Vlt?,NIT� � •.. G LUC.1�:. ' C1NS:�:: ,.. :' ' ..,.;. .: . . ... .......: ....•. • .. .
<br /> I.NW STTE PLOT PLAN/MAP S UE3MY1'TED Wrin Tins PLAN ❑ 7 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED 123(sR;z63z,2w4] 4 13.4
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<br /> ..:.. .:.. : .....3?;.` :.•..:'::.....!OiITO..:....:.G�;ZSR;:aP ,...:::: ..:.:..........D::US.....:::C'::T...: ::;FU�I�4.,.:.::...:.+G ;....OD{S)';:::rhara''11'`
<br /> 1.CONTINUOUS HLECfRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) 49n s
<br /> WMI AUDIBLE AND VISUAL ALARMS.(23 cck WZ 2634)
<br /> SECONDARY CONTAINMENT IS: a.DRY ❑ b.LIQUID FILLED ❑'c.PRHSSURUED El d.
<br /> UNDER VACUUM 4 6.
<br /> PANEL MANUFACTURER- Veeder-Root 4ha1MODEL II: TICS-350 4`'�&
<br /> LEAK SENSORMANUFACTURER: V er-Root4 MODEL#(S): Ljggid Sengj Series 794380.407
<br /> -17-2"x OMATIC TANK.GAUGING(ATG)SYSTEM USHD TO MONITOR SINGTX-WALL TANK.Sj(23 ccs 42643) x9011:
<br /> PANEL MANUFACTURER 490.12 MODEL#: 490-13
<br /> IN-TANK PRODS MANIUFA LJ FR:
<br /> 490.14. MODEL#(S). 490-13.
<br /> LEAK TI:S'1 FRRQUENCY: ❑ a.CONTINUOUS DAILY/NIGHTLY UC.WEEKLY 490.16
<br /> ❑ d.MONTIILY ❑ e.OTI]ER(Specify): 490-17.
<br /> FROG a.D TESTS: ❑ 0.1 g.p.h. C1b,0.2 8,p-h, ❑ c.OTHER(Specify): 490-19.
<br /> ..,.__...�� ...�._.._.._• 490.14:.,...
<br /> ❑ 3.MONTIiLY STATISTICAL INV HNTORY RECONCILIATION ia7 cot§2646 1] 490-20.
<br /> ""b"4.WEEKLY AL TANK GAU(1IN-G(MIG)Ire CCR 426451 TESTING PERIOD: ❑ a.36 HOURS ❑ b,60FtOt1RS
<br /> 490-21.
<br /> .,._... 490.22.
<br /> ❑ S.TANK INTE-GRTTY TESTING PER[23 C,ck p3.1] 4w�«;
<br /> 490-24.
<br /> TEST ME-QUENCY: ❑ a.ANNUALLY ❑ b,B1.ENNiAt,LY q-�c.OTHER(Specify): _•-.9 4424.
<br /> . ••. OTHER(Specify):
<br /> a -a7.
<br /> .,.. ,.�..:.:. :•: �<::V:; •: :E:. IV�..;�..•:Q.... . ..�'x.•;� : E••..•.;U!.....:.....:....::�: ...:...Cx:;..::.. ,.• []I;I�• �TN•.C..�.:;::...:•... :....Q! O`::. alias .. all
<br /> ® 1,CONTINUOUS MONITORING OF PIPEIPIPINCT SUMP(S)AND OTIIER SECONDARY CONTAINMENT WITH AUDIBLE&VISUAL ALARMS. 19o•2a
<br /> PCCR SECONDARY CON•rAIN IS! 0 a.DRY ❑ h.LIQUID FILLED 9 e.PRESSURIZED ❑ d.UNDER VACUUM 440 29.
<br /> 1326361
<br /> PAN M- MANUFACTURER;Veeder-Root 01-40- MODEL M TILS-350 4'X1.11
<br /> LEAK SENSORMANUFACTURER; Veeder- oot 490-32. MODEL#(S): i u- Sjes 794 311 ox 4W33.
<br /> PIPING LEAK ALARM TRIGGERS AUTOMATIC:PUMP(i.e., INE)SHUTDOWN. 0 a YES ❑ b.NO 490.31.
<br /> FAILUREtDISC ONNHCfION OF TIIE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SKUTDQWN. ® a.YES ❑ b.NO 4'0•36.
<br /> ❑ 2.MECHANICAL LINE LEAK DETECTOR(MELD THAI-ROUTINELY PERFORMS 3.0 8,p,h,I.E AIC 'I'F 'PS AND RESTRICTS OR SHUTS OFF §'ass.
<br /> PRODUCT FLOW WHEN A JRAK 1S DETECTED.123 CCR§a8361
<br /> : 49+537. MODIrI.$(S):
<br /> ($) 4 3R
<br /> 3.ELECTRONIC LTNF,LEAK Df:I-ECfOR(ELLD)TI-IAT ROUTINELY PERFORMS 3.0 g.p h.LEAK TESTS,tai cc:Rpor,] 490 39
<br /> ELLD MANUFACTURER(S):V der-Root 490 aq MODEL (S):1?i.>G i3 series. 49041
<br /> PROGRAMMED IN LINE LEA1C'1-F:51-: ❑ a,MINIMUM MONTITLY 0.2 g.p.h. ❑ b.MINIMUM ANNUAL.0.1 g.p.h. 490.42.
<br /> HLLD DETECTION OF A PIPING LEsAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ® a,YF1 ❑ b.NO 49D-43.
<br /> ELLD FAII.UR'E/DTSCO ON TRIGGERS AUTOMATIC PUMP SHUTDOWN, a.YES ® b.NO 490'41,
<br /> ❑ 4.PIPE INTFORITY TESTING. 49645
<br /> TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS o.OTHER(Specify) 4". 7.
<br /> ❑ 5.VISUAL PIPE MONITORING.
<br /> FMUFNCY: ❑ a.BADLY p b.WEEKLY ❑ G MIN.MONTHLY&EACH TLIAL SYSTEM OPERATED* 4'
<br /> • "Aitaw,�t RrY alosui0rinit of 9nbll�ad G11eaB�Y genersfarfi�ei yipingoaly rns HSC§Z4�R1 s 1'
<br /> _. : _.e.............. �..,.,.. __....
<br /> ❑ 6.Sl7CTION PIPING MEETS EXEMPTION CRITERIA.PCCR I2 06)(1)] 4W50.
<br /> _❑ 7.NO REGULATED PIPING PHR 142ALTII AND SAFETY CODF;,DIVISION 20,Cf 6.7 IS CONNECTED TO THS'IANK SYSTEM. 490 53.
<br /> _..... ._ .490.52
<br /> ❑ 99.OTHER(Spccifj) 4«1 53
<br /> zoar� AMVJXOD 91Daa0Xd KOHAaHD YVd tz:ST zT09/6T/To
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