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UNIFIED PROGRAM CONSOLIDATED FORM 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 USTs AT THIS FACILITY, 490-2 Check one item only) 2.THIS PLAIN COVERS ONLY THE FOLLOWING UST SYSTEMS, TANKS 1,2,3 U, FACILITY:.INFORMATION FACILITY ID#(Agency Use Only) - 1 BUSINESS NAME(Same as FACILITY NAME) COSTCO GASOLINE (LOC. NO. 1091) 3• BUSINESS SITE ADDRESS 2580 REYNOLDS RANCH PARKWAY 103• CITY LODI 104 II.EQUIPIVIENT;TESTING AND PREVENTIVE MAINTENANCE. Testing,preventive maintenance,and calibration of monitoring equipment(e.g.,sensors,probes,tine leak detectors,etc.)must be performed at the frequency specified by the equipment manufacturers'instructions,or annually,whichever is more frequent,and that such work must be performed by qualified personnel. 23 CCR2632.L634,26L%2641 EQUIPMENT IS SERVICED 1.ANNUALLY ❑ 99.OTHERS eci 490-3aMONITORING E Q (Specify): 490-3b 11iIII.M®NITORING L.O.CA'1�`14N$ 1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. ❑2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 2634)4 go4 TANICIVI6.NIT®RING!'S**.'Pg'*R)FOR1VI.LD.USING THE FOLLOWING METROD(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: Ela.DRY b.LIQUID FILLED [I c.c.PRESSURIZED ❑d.UNDER VACUUM 490 6 PANEL MANUFACTURER: Veeder-Root - 490-7' MODEL#:TLS-35OR 490-8 LEAK SENSOR MANUFACTURER:Veeder-Root 490-9' 1 MODEL AS):794380-301 _ 490-10 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANKS(23 CCR§2643) 490-i1 PANEL MANUFACTURER: 44x°3' MODEL#: 490-13 IN-TANK PROBE MANUFACTURER: 490-14. MODEL#(S): -��-�� 490-15 LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILYMIGHTLY ❑ c.WEEKLY 490.16 -...._... ...__..._............_................................................_ [ d d.-MONTHLY------ _... 3e: 490-17.... ..OTHER5eci ):-_ PROGRAMMED TESTS: ❑ a.0.1 h. ❑ b.0.2 h. ❑ c.OTHERS eci 490-18 g.p.h. g•P• (Specify): 490-I9 ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 490-20 ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§2645). TESTING PERIOD: ❑ a.36 HOURS El b.60 HOURS 490-2 a 22 ❑ 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 490-23 490-24 TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): 44a-25 ❑ 99.OTHER (Specify): 490-26490-27 V;PIPE 1VIONITORING:IS PERF4IiIVIED.USING TIIEUI�Nt 1VIETHQD(Sj.(Check alt thal.. PPIY) 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 490-29 VISUAL ALARMS. (23 CCR§2636) SECONDARY CONTAINMENT IS:❑a.DRY Eb.LIQUIDFILLED [3c.PRESSURIZED Md.UNDERVACUUM 490.29 �.__-..-------_____ __ _._ ... ... PANEL MANUFACTURER: Veeder-Root 0-90-30 MODEL#:TLS_-35OR 490-31 LEAK SENSOR MANUFACTURER:Veeder-Root 0-90-32 MODEL#(S): 784380-208,794380-3.0_4Vw 440-33 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. E a.YES [jb.NO� _ 490-34 FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. E 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 PRODUCT FLOW WHEN A LEAK IS DETECTED 23 CCR 2636 490-36 MLLD MANUFACTURER(s): FE Petro 490.37 MODEL#(S):STP-MLD-D 490.38 3,ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS (23 CCR§2636) 490-39 ELLD MANUFACTURER(!)Veeder-Root 490-'- MODEL#(S): 848480-0_01 490.41 PROGRAMMED IN LINE LEAK TEST: 1.MINIMUM MONTHLY 0.2 g p.h. 2.MINIMUM ANNUAL 0.1 g.p.h. 4`042- ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. E a.YES ❑b.NO 490-43 ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. a.YES C❑b.NO 49044 ❑ 4.PIPE INTEGRITY TESTING 490.45 TEST FREQUENCY ❑ a.ANNUALLY b.EVERY 3 YEARS ❑ c.OTHER(Specify) 490-46490.47 ❑ 5.VISUAL PIPE MONITORING. 49049 FREQUENCY ❑ a.DAILY ❑ b.WEEKLY ❑c.MIN.MONTHLY&EACH TIME SYSTEM OPERATED* 490.49 *Allowed for nionitaring of unburied meWncy gancrator fuel piping only per HSC§25281.5(b)(3) ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR§2636(a)(3)1. 490-50 ❑ 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 14573-F-APPL-TANK PERM...Revised-2012-09-20.pdf