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a a UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN - Pae 1 of 2 TYPE OF ACTION ❑ 1. NEW PLAN 2. CHANGE OF INFORMATION 4941 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( 1. FACILITY INFORMATION FACILITY ID # (Agency Use Only) _ - 1 BUSINESS NAME (Same as FACILITY NAME) 3. BUSINESS SITE ADDRESS 103 CITY 104. If. EQUIPMENT TESTING AND REVE MAINTEN120410E Testing, preventive maintenance, and calibration of monitoring equipment (e.g., sensors, probes, line teak 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 §2632,2634,2638,2641 MONITORING EQUIPMENT IS SERVICED 1. ANNUALLY ❑ 99. OTHER (Specify): �3b III. MONITORING LOCATIONS 1. NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. PLI SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR §2632, 2634 IV. TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): 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: Aa. DRY ❑ b. LIQUID FILLED ❑ c. PRESSURIZED ❑ d. UNDER VACUUM 4946 -490 �TMODEL #: PANEL MANUFACTURER: �-)`�� 0-8 -� _� LEAK SENSOR MANUFACTURER:'�' 490 O #(S): 490-10 2. AUTOMATIC TANK GAUGING (ATG) SYSTENTUSED TO MONITOR SINGLE WALL TANK(S), (23 CCR §264) 490.11 PANEL MANUFACTURER: 49412. MODEL #: 490-13 IN -TANK PROBE MANUFACTURER: -- ----490.14- MODEL #(S): -__ 49415_ _- LEAK TEST FREQUENCY: ❑ a. CONTINUOUS ❑ b. DAILY/NIGHTLY ❑ c. WEEKLY 49416 ❑ d. MONTHLY ❑ e. OTHER (Specify): _ -- --- ------------------------------ -------------------------------------------------- 490-17 PROGRAMMED TESTS: ❑ a. 0.1 g.p.h. ❑ b. 0.2 g.p.h. El c. OTHER (Specify): ��y 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 C3b. 60 HOURS 490-21 490-22 tj 5. TANK INTEGRITY TESTING (23 CCR §2643.1): 490-23 TEST FREQUENCY: ❑ a. ANNUALLY Elb. BIENNIALLY ❑ c. OTHER (Specify): 49424 490-25 ❑ 99. OTHER (Specify): 49426 49427 V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply) 1. CONTINUOUS MONITORING OF PIPE/ PIPING SUMP(S) AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 490 -2i - VISUAL ALARMS. (23 CCR §2636) SECONDARY CONTAINMENT ISAa. DRY ❑b. LIQUID FILLED 0c.PRESSURIZED ❑d. UNDER VACUUM 49429 PANEL MANUFACTURER: ''E j _ _440 30 i MODEL #: �L 1-rj - 490-31 LEAK SENSOR MANUFACTURER: ��p �- 49432 I MODEL #(S)^ 4500-3 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP (i.e., TURBINE) SHUTDOWN. - ❑ a YES b. NO 49434 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 PRODUCT FLOW WHEN A LEAK IS DETECTED(23 CCR 12f36`_- 490-36 MLLD MANUFACTURER(S): "' 49437 MODEL #(S): > 49438 ❑ 3. ELECTRONIC LINE LEAK DETECTOR (ELLD) THAT ROUTINELY PERFORMS 3.0 g.p h. LEAK TESTS (23 CCR §2636) 49439 ELLD MANUFACTURER(S) 49040- E MODEL #(S): 49°-41 PROGRAMMED IN LINE LEAK TEST: ❑ 1. MINIMUM MONTHLY 0.2 g p.h. ❑ 2. MINIMUM ANNUAL 0.1 g.pA 49442 ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a. YES ❑ b. NO 49043 i ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a. YES ❑ b. NO 49044 El 4. PIPE INTEGRITY TESTING 490-4s TEST FREQUENCY a ANNUALLY b. EVERY 3 YEARS c- OTHERS 4944649447 5. VISUAL PIPE MONITORING. 49048 FREQUENCY ❑ a DAILY ❑ b. WEEKLY ❑ e. MIN. MONTHLY & EACH TIME SYSTEM OPERATED- 49049 • Allowed far mommng of unburied emagency jenerawr fuel pipmg oWy per HSC 25281. 3 ❑ 6. SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR §2636(')(3)]. 490-50 7. NO REGULATED PIPING PER HEALTH AND SAFETY CODE, DIVISION 20, CHAPTER 6.7 IS CONI - 49451 ❑ 99. OTHER (Specify) R I V l L U/VLli►`c_ - - .o ov, � UPCF UST -D (12/2007)1/4