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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): 490-2& I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) L BUSINESS NAME(Same as facility Name or DBA) 3. BUSINESS SITE ADD S1°3. BUSINESS TE CITY 104. H. EQUIPMEN TESTIN 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 eguTr ent manufacturers'instructions,or annually,whichever is more frequent.Such work must beperformed by_q_mMiedpers_onnd.[23 CCR§232,2634,238,2641] -- -------- ---------.. --490-3& MONITORING EQUIPMENT IS SERVICED CR 1.ANNUALLY ❑ 99.OTHER(Specify): 490-3b. III. MONITORING LOCATIONS ❑ 1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED [23 CCR§2632,26341 4904. IV. TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) (h ht'apply) 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) 49-5. WITH AUDIBLE AND VISUAL ALARMS.123 CCR§2632,26341 SECONDARY CONTAINMENT IS: ]e a.DRY [Ib.LIQUID FILLED ❑ c.PRESSURIZED Eld.UNDER VACUUM 490.6. PANEL MANUFACTURER: L-013"< Ow-e-A- 490-7. MODEL#: LA-OZ 490-8. LEAK SENSOR MANUFACTURER: A14ejr- 490-9. MODEL#(S): L A-L-5 490.10. -------------- --------- ❑ 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.DAILYINIGHTLY ❑ c.WEEKLY 490-16. ❑ d.MONTHLY ❑ e.OTHER(Specify): 490-17. 490-I8. PROGRAMMED TESTS: -❑ a.0.1 g.p.h. - ❑ b.0.2 g_p_h_ - ❑ c.OTHER(Specify): ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION[23 CCR§2646 q 490-20, C] 4.WEEKLY MANUAL TANK GAUGING(MTG)[23 CCR§26451 TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS 49490zl. ❑ 5.TANK INTEGRITY TESTING PER[23 CCR§2643.1 1 490-23. TEST FREQUENCY: ❑ a.ANNUALLY [Ib.BIENNIALLY [:] c.OTHER(Specify): 490-25. . 490-26. ❑ 99.OTHER(Specify): 490-27. V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) thatakll � JK 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE&VISUAL ALARMS. 490-28. [21 CC §2 361 SECONDARY CONTAINMENT IS: 1�r a.DRY [Ib.LIQUID FILLED ❑ c.PRESSURIZED F1d.UNDER VACUUM 490-29. PANEL MANUFACTURER: /� 490-30. MODEL#: -6 490-31. L..L�9--y- A 4F,r�-4- LEAK SENSOR MANUFACTURER: Lp-a lyl; , -r7- 490-32. MODEL#(S): _/.� - 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 5q b.NO 490-33. A�NiE HANICAL LINE LEAKPRODUCT FLOW WHEN A LEAK S D!�� ) HATROUTINELY PERFORMS 3.0 g.p.h LEAK TESTS AND RESTRICTS OR SHUTS ' -36. `` A MLLD MANUFACTURER(S): \ V 490-37. MODEL#(S): `-,q L-0 L-� -38. -- ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS.[23 CCR§2361 490-39. 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 49043. ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ❑ b.NO 490-44 PIPE INTEGRITY TESTING. 49045. 49-46. TEST FREQUENCY: a.ANNUALLY ❑ b EVERY 3 YEARS ❑ c OTHER(Specify) 49047.- _ ❑ 5 VISUAL PIPE MONITORING. 490-48. FREQUENCY: ❑ a.DAILY ❑ b.WEEKLY ❑ C.MIN.MONTHLY&EACH TIME SYSTEM OPERATED. 49049. Allowed for nmto.r%of unburied emergency jenerator fue�ipingonly_per HSC_§25281,5(§X32__._. ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA.[23 CCR§236(ax3)] 490-50. ------- ------- ---- ----------- --- ------ .... _..------ ........... -------- ❑ 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS- TO THE TANK SYSTEM. 49°-51. El 99.OTHER(Specify) - - ------- -- -- a9asz. 49-53. UPCF UST-D(12/2007)-1/4 www.unidocs.org Effective 01/17/08