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01/05/2009 MON 13:46 FAX 2W83433 SJC EHD 2001 ********************* *** low- FAX TX REPORT *** ********************* TRANSMISSION OK JOB NO. 2146 DESTINATION ADDRESS 98251532 PSWD/SUBADDRESS DESTINATION ID ST. TIME 01/05 13:43 USAGE T 02' 32 PGS. 6 RESULT OK UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN-(Pae I of 2) TYPE OF ACTION 1.NEW PLAN ❑ 2.CHANGE OF INFORMATION 490-1 PLAN TYPE ❑ 1.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. 4/0-2. (Check one item only) ❑ 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) BUSINESS NAME(Same as Facility Name or DBA) 3, 3 BUSINESS SITE ADDRESS (( t03 CITY 100- ��(� _ ��a?2yt1�Jz w-`l� /,1--/v`T E C1- . II. EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE 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 e manufacturers'instructions_or annually whic_hever is more fre uq ent.Such work must be�erformed by_qualified_personnel Iz3 c4 R§2632,2630-_2638,26411 MONITORING EQUIPMENT IS SERVICED 1.ANNUALLY El99.OTHER(Specif 490-3&y)� 490-3b. III. MONITORING LOCATIONS ❑ L NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN ❑ 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED 123 CCR§2632,26341 490.4. IV. TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) ;ahteak all r ❑ 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) 49o•s. WITH AUDIBLE AND VISUAL ALARMS.I23 CCR§2632,26341 SECONDARY CONTAINMENT IS: 14 a.DRY ,�❑ b".LIQUID F LED ❑ c.PRESSURIZED ❑ d.UNDER VACUUM 490.6. PANEL MANUFACTURER: /ir�v )L 490.7 MODEL#: -T t'S' �� 0 S r/ 490-8. LEAK SENSOR MANUFACTURER: 411-9. MODEL u(S)__'7,9CO�O- 490.10. ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).123 CCR§2(431 490.11. PANEL MANUFACTURER: 490-12. MODEL M: 49°-1s. IN-TANK PROBE MANUFACTURER: 4130.14. MODEL k(S): 490.15. LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY 490.16. ❑ d.MONTHLY ❑ e.OTHER(Specify): 490.17. 49°-18. _ PROGRAMMED TESTS: ❑ a.0.1 g.p.h. ❑ b.0.2 g.p.h_- ❑ c.OTHER(Specify): 490.19. El3.MONTHLY STATISTICAL INVENTORY RECONCILIATION 123 CCR§2646.11 490-20. El 4.WEEKLY MANUAL TANK GAUGING(MTG)123 CCR§26451 TESTING PERIOD: C1a.36 HOURS F-1 b.60 HOURS 4 940_ z1 ❑ 5.TANK INTEGRITY TESTING PER 123 CCR§2643.11 490.23. 490.24. TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify):- 490-25= 490.26. ❑ 99.OTHER(Specify): 490.27. ll V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) 1alakapply) ❑ 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE&VISUAL ALARMS. 490-29. 123 CCR SECONDARY CONTAINMENT IS: It a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED ❑ d.UNDER VACUUM 490-29. §26361 PANEL MANUFACTURER: I 4A®d 0-y - �a� 490-30. MODEL M: 7 S �� 5 f/490-31. LEAK SENSOR MANUFACTURER: 490.32. MODEL H(S): I c) .- 3r---490-33' PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. 4 a.YES ❑ b.NO 490-34. FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. 1 a.YES ❑ b.NO 490-35. [� 2.MECHANICAL LINE LEAK DETECTOR(MLLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS AND RESTR TS OR SHUTS OFF 490-36. PRODUCT FLOW WHEN A LEAK IS DETTT D.123 CCR§ 361 ) 0 1 �., < _ % Ct_ MLLD MANUFACTURER(S): 171L/�-- � J 490.32MODEL#(S): 490-38. 0 3.ELECTRONIC LINE LEAK DETECTOR(EL(D)T AT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS,123 CCR§26361 S i 490-39. ELLD MANUFACTURER(S): - S�-- 0-w 4°. MODEL k(S): ��- +-LL f� X41