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r SCE#M73 Vr4ffUD PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONIT ORDING P -jPav 1 of 2) TYPE OF ACTION 0 i.NEW PLAN ❑ 2.CHANGE OF INFORMATION 4t PLAN TYPE M 1.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. (Cl=k one item only) 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM( I I: FARC N FACILITY ID#(Jgwcy Use Ivy 1 BUSINESS N (Same as FACILITY NA COSTCO GASOLINE FACILITY #1091 3' BUSINESSSITEADD SS 322 E. HARNEY LANE to3. CITY LODI 104 IL EQUIPMENT G: . hUPMNANCE Testing,preventive maintenance,and calibration of monitoring equipment(e.g.,wasors,probes:line leak deteeton,etc.)must be performed at the frequency specified by the equipment ufac 'instructions.or annually.whichever is mom frequent, d that such work must be performed by qualified personnel. (23 CCR§2632,2634,2638.264 0 MONITORING EQ IS SERVICED 1. ALLY [399.0 (S 490.3. MO (Specify): 490.31, III„MOMTORING LOCAUONS 1.NEW SITE PLOT PLANAIAP SUBMITTED WITH THIS PLAN. U 2.SITE PLOT PLANIMAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 26304904 .T 0 ITOWNG.I . 4?AAVWUM XG T=FOI.LOWMG'MET,HOD,($): 1.CONTINUOUS ELECTRONIC TANK MONITO ING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT 4W5 vAULT(S)WITH AUDIBLE AND VISUAL ALARMS. (23 CCR§2632,2634) SECONDARY CONTAINMENT IS: ❑ a.DRY C9 b.LIQUID c.PRESSURIZED ❑d.UNDER VAC 4 pANELMANUFACTURER. VEEDER-ROOT 4904' MODEL#.TLS-350R a LEAK SENSOR MANUFACTURER. VEEDER-ROOT 49' MODEL S): 794380-301 t0 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SIN» .-W L .TAN tS3.(23 CCR§2643) 49o•t1 PANEL MANUFACTURER: 4 .12` MODEL#: 413 IN-TANK PROBE AC 490-14. MODEL#(S): 490'11 LEAK TEST FREQUENCY: a.CONTINUOUS b.DAILY/MGHTLY 13 c.WEEKLY 490.16 d MONTHLY e O (S ify): 490-17 019 PRO TESTS: a.0.19•P-h b.0.2 g•p•h c.0 (S e if} � 49t9 ❑ 3.MONTHLY STATISTICAL IN"V%NTORY RECOINCILJATION(23 CCR§2"1): 4 .20 [34.V4 Y MANUAL T GAUGING(MTG)(23 CCR§264.5). PERIOD: a.36 HO ❑ b.60 HOURS .4i xi 3.TANK wmGRrff TESTING(23 CCR§2643.1). 4W2,1 TEST FREQUENCY: [3a.ANNUALLY [3b:BIENNIALLY c.OTHER(Specify): a2s 490.26 13 49.OTHER(Specify): 427 V-ME0 C t* ,...: ITIS G . :;." 2 t? G OD (Cbetk Adult apply) 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 490-29 VISUAL ALARMS. (23 CCR§2636) Piping Sump Paging SECONDARY CONT TIS,Ma.DRY 0b.11QUIDFILLED 0c.PRESSURIZED WUNDERVACUUM429 PANEL MANUFACTURER. ER-ROOT 4""" MODEL#:TLS-35OR 490.31 LEAK SENSOR UFA E -ROOT 490.32 MODEL#(S): 857080-112 33 PL19NGLEAKALARM IGGERAUTOMATIC P (i.e.. )SHUTDOWN. 12aYES 0 b.NO 34 FAILUREIDISCONNECTION OF THE MONITORING SYSTEM TRIGGERSAUTOMATIC PUMP SHUTDOWN. Ma YES ❑b.NO 33 2.MECHANICAL LINELEAK DETECTOR(MLLD)THAT ROUTINELY PERFORMS 3.0 gp h.LEA TESTS AND RESTRICTS OR SUM OFF PRODUCT FLOW WHEN A LEAK IS DETECTED 23 C 2 36 MLLD MANUFACTURER(S): 37 MODEL#(S): 490:33 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERPORMS 3.4 g p h.LEAK TESTS (23 CCR§2 39 ELLD 1FA (S) T 49040- MOD #(S): 848480-001 49041 PROGRAMMED IN LINE LE 1.MR41MUM MONTHLY 0.2 g.p h. tU 2.MWIMUM ANNUAL 0.1 g.p.h. 4 9042 ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PIW SHUTDOWN. rX1 a YES ❑b.NO 4W43 ELLD FAILURE/DISCONNECTION GGERS AUTOMATIC PUMP SHUTDOWN. ffl a ❑b.NO 4 4.PIPE vNTEGRITY TESTING .0SCY a. Y b.EVERY 3 490-46490-47 S.VISUAL PIPE MONITORING. 4 FREQUENCY a.DAILY b.WEEKLY ❑c.MIN.MONTHLY&EACH TIME SYSTEM OPERATED- 4 for *funbuded coos fadeosl tiSC 552&1. b 31 ❑ 6.SUCn0N PIPING MEETS O1N CRITERIA 123 CCR§2636(aX3)y. 490-50 7.1N0 REGULATED PU9NG PER HEALTH AND SAFETY CODE,DtVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM 4st E3R( )99. asa 32 490-x3 UPCF UST-D(12/2007)1/4