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4 UNIFIED PROGRAM CONSOLIDATED FORM BCE #14573 UNDERGROUND STORAGE TANK MONITORING PLAN- (Pae 1 of 2 TYPE OF ACTION ❑ 1.NEW PLAN 2.CHANGE OF INFORMATION 490 1. PLAN TYPE ❑ 1.MONITORING IS IDENTICAL FOR ALL UST's AT THIS FACILITY. 490-2. (Check one item only) 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): Tank#4-LUBRIZOL I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) i•'' BUSINESS NAME(Same as Facility Name or DBA) 3. Costco Gasoline(Loc.No. 1091) BUSINESS SITE ADDRESS 103• CITY 104. 2680 REYNOLDS RANCH PARKWAY LODI H. E NT 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 ScEipment manufacturers'instructions,or annually,whichever is more Pnuent.Such work must be performed by qualified personnel.[23 CCR§2632,2634,2638,26411 MONITORING EQUIPMENT IS SERVICED (Specify): 490.3b. 1.ANNUALLY ❑ 99.OTHER S eci 0-90.32. MONITORING LOCATIONS 1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN ❑ 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED [23 CCR§2632,2634] 490-4. IV. TANK MONITORING IS PERFORMED USING THE FOLLOWING METHODS) ta�kall ❑� 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 ❑Q b.LIQUID FILLED ❑ c.PRESSURIZED ❑ d.UNDER VACUUM 49"_ PANEL MANUFACTURER: Veeder-Root 490-7. MODEL#: TLS-350R 49". LEAK SENSOR MANUFACTURER: Veeder-Root 490-9, MODEL#(S): 794380-303 490-M - ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).[23 CCR§26431 0-90'1. 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 ❑ c.WEEKLY 490-16. ❑ d.MONTHLY ❑ e.OTHER(Specify): 490.17. PROGRAMMED TESTS: ❑ a.0.I . .h. ❑ b.0.2 . .h. ❑ c.OTHER( ify): 490�y 1s' ❑ 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 490--al. ❑ S.TANK INTEGRITY TESTING PER[23 ccR§2643.11 490-23. TEST FREQUENCY: 0 a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHERS i 490 20-. 490.26. 99.OTHER(S i ): 490-27. V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING NIS T OI1(S) th(Check Xlf 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE&VISUAL ALARMS. ago zs. [23 CCR SECONDARY CONTAINMENT IS: a.DRY b.LIQUID FILLED ❑ c.PRESSURIZED d.UNDER VACUUM 490-'- PANEL MANUFACTURER: Veeder-Root 490.30. MODEL#: TLS-350R 490-31. LEAK SENSOR MANUFACTURER: Veeder-Root 490.32. MODEL#(S): 323, ,857280-100 49111- 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. N a.YES ❑ K NO 490.35. Q 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.123 CCR026361 MLLD MANUFACTURER(S): FE Petro 490.37. MODEL#(S): MLD-D 490-38. ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS.[23 CCR§26361 496'39• ELLD MANUFACTURER(S): 490-40. MODEL#(S): 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. a9oas. TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(S i ) 4 . 5.VISUAL PIPE MONITORING. 490-4& FREQUENCY: ❑ a.DAILY ❑ b.WEEKLY ❑ c.MIN.MONTHLY do EACH TIME SYSTEM OPERATED- 490-49- *Allowed for monitoring o€unburied erator fimel pimHSC§25281.5(b)(3) ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA.[23 ccR§2636(a113)] 490-50- 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM. 490-51. 490.52. 99.OTHER(Specify) 490.53. UPCF UST-D(1212007)-114 www.unidocs.org