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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN -(Page 1 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. 490-2. (Check one item only) ❑ 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): L FACILITY INFORMATION FACILITY ID#(Agency Use Only) t• BUSINESS NAME(Same as Facility Name or DBA) 3. Chevron Station#209167 BUSINESS SITE ADDRESS 1234 Yosemite Ave 103. 1 CITY Manteca, CA 95336 104 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 thS e i�ment manufacturers_instructions,or annual Hfiichever is more frequent.Such work must be performed by qualified ersonneL[23 ccR§2632^2634,z63s,26411 EQUIPMENT IS SERVICED ® 1.ANNUALLY ❑ 99.OTHER(Specify): 490-3b. MONITORING E Q 490-36. III. MONITORING LOCATIONS ❑ 1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN ❑ 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED [23 ccx§2632,2634] 490-4. IV. TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD (S) that Ix zrr 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) 490-5. WITH AUDIBLE AND VISUAL ALARMS.[23 CCR§2632,26341 SECONDARY CONTAINMENT IS: ® a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED ❑ d.UNDER VACUUM 490-6. PANEL MANUFACTURER: Veeder-Root 490-7- MODEL#: TLS-350 490-8. LEAK SENSOR MANUFACTURER: Veeder-Root 990 MODEL#(S): Liquid Sensor Series 794380-409 490-10. _ - _..__...__ ..._.........__._........_..._.....__........... _.............. ..... - ... - -- ----._� _._.._...._.._........_.......__............................_.................................................,............__..,...........,.._..,..................... �] 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 b.DAILY/NIGHTLY U c.WEEKLY 490-16. ❑ d.MONTHLY ❑ e.OTHER(Specify): 490-17. PROGRAMMED TESTS: ❑ a.0.1 g.p.h. ❑ b.0.2 g.p.h. ❑ c.OTHER(Specify): 4 4W 18. __..._...._.._....................._._..............._............_______._...._-____-.-....._.____....__.._..._____-____.__..._.._____.-_............____......................._....._.........._._.._....._....__.__..___._.___._._________._.._-----.__ _..........._.................... ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION[23 CCR§2646.11 490-20. �_-_--.-_-___..... _ _ _......._.__...................-_..........................................._.__..._.._....._..._.._.._.............._.....__....__.....___._.._. ..... _ __.........................._._........_........................._......................................-____-...--...-................_............ ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)[23 CCR§26451 TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS 4� z1' ._.._.... _......_.._.._..._.._......_.....__............... _......-_._._.._.............._......_..................._....._..._.._._.._.._....__.._........_._... - - .._... ------------ 0 -------- ---_.............................._.. ❑ 5.TANK INTEGRITY TESTING PER[23 CCR§2643.11 490-23. TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): 490-25, _._.._.__._._....._._._.._._._................__......._......._._......_........ ..._......._........_.___..._.._._.._...._._..-_---...---..____._.._..____.___........_....._.._........................_.._..._.._....__........____.-.__...__........._.....__._____..._.._._.. Q 99.OTHER(Specify): 490-26. 490-27. V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHODS) thata`k 111 ® 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. §26361 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 490-40. 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. 490-42. 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 C3 c.OTHER(Specify) 490-447.7. S 1f 49046. Q ❑ 5.VISUAL PIPE MONITORING. 490-48' FREQUENCY: ❑ a.DAILY ❑ b.WEEKLY ❑ C.MIN.MONTHLY&EACH TIME SYSTEM OPERATED* 490-49. ......................... *Allowedform todn&-of unMui�,emer�ency_&enactor fuelpi�in�,only er,HSC-25281.SS��................... ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA.[23 CCR§2636(a)(3)1 4.90-50. . _.. __..._._...._.._.__..._.._... ............_.........-- _ - _.. -_____ __..._ -----._. __._-_------__- ........ _-__ - - .................._.._.............. - - ----------------------------------------------------------------------------------__.._._._.......... ........ ❑ 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM. 490-5i. __ _--_-_-___-----_.._.._-_-- ... __..................._....._.._..-......_.._._.._.._.._......._.._---..._............___...._....._..._ _._.....- --------- - -- -------------_..__.........................---_------------...........-................,.... 0 99.OTHER(Specify) 490-53.