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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN-(Page I of 2) TYPE OF ACTION ❑1.NEW PLAN 2.CHANGE OF INFORMATION 4907 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)- 1. FACELITY ENFORMATION FACILITY ID#(Agency Use Only) 1 BUSINESS NAME(Same as FACILITY NAME) U 3_ BUSINESS SITE ADDRESS �V ?. CITY 164 H EQUIPMkff 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 equipment manufac4 m'instructions,or annually,w>1 ,er 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): 490-3 490.36b III. ONTl' G, ATIONS ❑1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN.Pr2.SITE PLOT PLANIMAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 2634)49o-4 M OL TV.TAW MONITORING IS PERFORNM USING.T11E FOILOWINGMETHOD(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: X a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED ❑d UNDER VACUUM 490-6 PANEL MANUFACTURER: •C, 4�a. MODEL#:�Tiz 'a so 49M LEAK SENSOR MANUFACTURER: _gyp 490.9' MODEL#(S): f� 490.10 Lj 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK/&(23 CCR§2643) 490-11 PANEL MANUFACTURER: 490-I2. MODEL#: 490-13 IN-TANK PROBE MANUFAC 114' MODEL#(S): 490-15 LEAK TEST FREQUENCY: CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY 490-16 ❑ d.MONTHLY ❑ e.OTHER(Specify): 490-17 PROD TESTS: ❑ a.0.1 g.p.h. ❑ b.0.2 g.p.h. ❑ c. (Specify): 490.19 ❑ 3.MONTHLY STATISTICAL RY RECONCILIATION(23 CCR§2646.1): 490-20 4.WEEKLY MANUAL T: ;AUGING G)(23 CCR§2 TESTING PERIOD: 0 a 36�HOURS b.60 HOURS 490-21 490.22 5.TANK INTEG --- -•i(23 CCR§2643.1): 49023 TEST FREQUENCY 7NUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): 49024 490-25 ❑99.OTHER (Specify): 490.26 490.27 V.PIPE MONITORING ISPERFORMED USING ME FOILOWING OD(S)(Check A that apply) 1.CONTINUOUS MONITORING OF P"" i'SUMP(S)AND O SECONDARY CONTAINMENT AUDIBLE AND 490.2s VISUAL A (23 CCR§2636) SECONDARY CONTA IS: a.DRY ❑b.LIQUID FILLED [],.PRESSURIZED ❑d.UNDER VACUUM 490-29 PANEL MANUFACTURER: MODEL#: f 490-31 LEAK SENSOR MANUFACTURER: 490.32 MODEL#(S): 490.33 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. a. ❑b.NO 49034 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.L LEAK TESTS AND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK IS DETECTED 23 CCR JgM 490-36 MLLD MANUFACTURER(S): 490-37 MODEL#(S): ( JCJ 490438 ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 gp.h.LEAK TESTS (23 CCR§2636) 490-39 ELLD MANUFACTURER(S) 490.40' 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 TRIC�1`700 --OMATIC PUMP S-1UTDOWN. ❑&YES ❑b.NO 490'44 4.PIPE INTEGRITY TESTING 490.45 TEST FREQUENCY a.ANNUALLY :VERY 3 YEARS 13 c.OTHERS i 49046490.47 5.VISUAL PIPE MONITORING. 49048 FREQUENCY ❑ a.DAILY ❑ b.WEEKLY ❑C.MIN.MONTHLY&EACH TIME SYSTEM OPERATED* 49049 "Allowed for monitorigg of unburied enwrigaicy generator fuel piptM only gE HSC 25nl.5 3 ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR§2636(aX3)1. 49050 Lj 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM 490.51 ❑ 99.OTHER(Specify) 490.52 490-53 UPCF UST-D(12/2007)1/4