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UNIFIED PROGRAM CONSOLIDATED FORM BCE #14573 UNDERGROUND STORAGE TANK MONITORING PLAN- (Page 1 of 2) TYPE OF ACTION ❑ 1.NEW PLAN ® 2.CHANGE OF INFORMATION 49x1. 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): Tank#4-LUBRIZOL TY INFORMATION ' ..:.:::.:::..:...............:.........:................... .. ...... I..FACILI FACILITY ID#(Agency Use Only) FT I BUSINESS NAME(Same as Facility Name or DBA) 3. Costco Gasoline(Loc.No.1091) BUSINESS SITE ADDRESS 103• CITY 104. 2660 REYNOLDS RANCH PARKWAY LODI 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 manufacturers'instructions,or annually,whichever is more frequent.Such work must be performed by qualified personnel.[23 CCR§2632,2634,2638,26411 MONITORING EQUIPMENT IS SERVICED ® 1.ANNUALLY ❑ 99.OTHERS eci 490-J ( P $')� 490-3b.. :.,... III...MONITORING LOC AtI ® 1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN 1-12.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED [23 CCR§2632,26341 4904. ..::...:..:::..:...:..:::...:.:::.....:.....:..:..:.:..:.........>..::.....:....:,...:..............::..::....:........:.:.:::.,..:.........:....:..:..:....:...........:.,....:..................;...:....;.::.:.:.,;::::C eakall_'. .'; xV;''TANI IVXQNZTORIPTG:IS:PERF'.ORMED USING THE FOLLOVING'JyIETI3QD(S):.:`h 1 i` ` © 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) 490-5- WITH AUDIBLE AND VISUAL ALARMS.(23 ccR§2632,2634} SECONDARY CONTAINMENT IS: ❑ a.DRY 9 b.LIQUID FILLED ❑ c.PRESSURIZED ❑ d.UNDER VACUUM 49"- PANEL MANUFACTURER Veeder-Root 490-7' MODEL#: TLS-3508 490.9' LEAK SENSORMANUFACT490-9. UREA: Veeder-Root MODEL#(s): 794380-303 490-10. ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).[23 CCR§2643) 490 is PANEL MANUFACTURER: 490.12' MODEL#: 490-13. 49.0-.14-.--MOD1:L.. -- -- 19o-D- .--------iN'IANK PROI3@"M-AiVUFACTI7RER� ._._._. #(S}: - LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILYINIGHTLY ❑ c.WEEKLY 490.16. ❑ d.MONTHLY ❑ e.OTHER(Specify): 490617' 490.18. PROGRAMMED TESTS: _❑ a.0.1 g.p.h. ❑ b.0.2 g.p.h. ❑ c.OTHER(Specify}: 490-19. [13.MONTHLY STATISTICAL INVENTORY RECONCILIATION[23 CCR§2646.1] 490-20- ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)[23 ccR§z6451 TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS 490-22. 21. ❑ 5.TANK INTEGRITY TESTING PER[23 CCR§2643.11 490-23' TEST UENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): 4904-25 z0-. FRE 490-26. ❑ 99.OTHER(Specify): 490.27. . Checkall.` PIPE'MONITURING IS.PERFQRMED US . THE.-FOLLO'WING,M----T © 1.CONTINUOUS MONITORING OF PIPEIPIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE&VISUAL ALARMS. 490-"- [23 6611 SECONDARX CONTAINMENT IS: Q a.DRY b,tTQUID FILLED ❑ c.PRESSURIZED ❑� d.UNDER VACUUM 490.29- 826361 PANEL MANUFACTURER: Veeder-Root 490 30' MODEL#: TLS-3508 490 31. LEAK SENSOR MANUFACTURER Veeder-Root 490-32, MODEL#(S): 794380-323,794380-304.857280-100 490-33. PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. [j) a.YES ❑ b.NO 490-'14' _ FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. Q a.YES ❑ b.NO 490-35. (] 2.MECHANICAL LINE LEAK DETECTOR(MLLD)THAT ROUTINELY PERFORMS 3.0 g.pJL LEAK TESTS AND RESTRICTS OR SHUTS OFF 490.36.. PRODUCT FLOW WHEN A LEAK IS DETECTED.[23 CCR§26361 MLLD MANUFACTURER(S): FE Petro 49x37' MODEL#(S): MLD-D 490.38. ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.b.LEAK TESTS.[23 CCR§2636] 490-39' ELLD MANUFACTURER(S): 49040. MODEL#(S): 490.41. PROGRAMMED IN LINE LEAK TEST: ❑ a.MINIMUM MONTHLY 0.2 g.p.b. ❑ b.MINIMUM ANNUAL 0.I g.p.h. 49042. ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ❑ b.NO 490-43- ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ b.NO 490.44- ❑ 4.PIPE INTEGRITY TESTING. 0-900-5. 490-46. (Specify)TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHERm, -- 49044 ❑ 5.VISUAL PIPE MONITORING. 11 [Iy�, 4 ' FREQUENCY: a.DAILY b.WEEKLY ❑ c.MIN.MONTHLY&EACH TIME SYSTEM[0%RATED* 490-49- "Allowed for monitoring ofunburied emerucncy ffcner,tm fuel piiin%only §25281-5(61(3) ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA.123 CCR§2636(,1(3)1 _ 490-50. ❑ 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SXSTF-M- Q 4951' 490-52. 99.OTHER(Specify) 490.0- UPCF UST-D(12/2007)-1/4 www.unidoes.org