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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN - LaLe I of 2) TYPE OF ACTION ❑ 1. NEW PLAN F12. 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)- L FACILITY INFO TION .: FACILITY ID # (Agency Use Only) - - ® 1 BUSINESS NAME (Same as FACILITY NAME) C A A)C-P-T P, IBJ A &II 3 BUSINESS SITE ADDRESS l}.Z N , �}-( (s 103' CITY j ---f ® -� lox. II. EQUIPMENT TESTING AND PREVE .: , .. MANCE 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, and that such work must be performed by qualified personnel. 23 CCR 2632 2634, 2638, 2641 MONITORING EQUIPMENT IS SERVICED 1. ANNUALLY El99.OTHER (Specify): 4�3b M. MONITORING.;OCATIONS ❑ 1. NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. ❑ 2. SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR §2632, 2634)490-4 TV. TANK MONITORING IS PERFO D iJSING'I H]E FOLI:UWING M1 THODM I. 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: A a. DRY ❑ b. LIQUID FILLED ❑ c. PRESSURIZED ❑ d. UNDER VACUUM 490.6 41. PANEL MANUFACTURER y MODEL #: 570 490.8 LEAK SENSOR MANUFACTURER: 41 MODEL #(S): 20 490-10 ❑ 2. AUTOMATIC TANK GAUGING (ATG) SYSTEM USED TO MONITOR SINGLE WALL TANK(S). (23 CCR §2643) 490-11 PANEL MANUFACTURER 490-12' MODEL #: 490-13 IN -TANK PROBE MANUFACTURER: 49x14' 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. 0.1 g.p.h. ❑ b. 0.2 g.p.h. ❑ c. OTHER (Specify): 490.16 490.19 ❑ 3. MONTHLY STATISTICAL INVENTORY RECONCILIATION (23 CCR §2646.1): 490.20 ❑ 4. WEEKLY MANUAL TANK GAUGING (MIG) (23 CCR §2645). TESTING PERIOD: E]a. 36 HOURS ❑ b. 60 HOURS 490.zi 5. TANK INTEGRITY TESTING (23 CCR §2643.1): 490-23 090-24 TEST FREQUENCY: ❑ a. ANNUALLY ❑ b. BIENNIALLY ❑ c. OTHER (Specify): 490-25 ❑ 99. OTHER (Specify): 490-26 490-27 V..PIPE MONITORING is' PERFORMED USING FOLLOWING N ETHOD(S) (Check aIi 00*001y) CONTINUOUS MONITORING OF PIPE! PIPING SUMP(S) AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 490-29 ISUAL ALARMS. (23 CCR §2636) SECONDARY CONTAINMENT IS: jOa. DRY ❑b. LIQUID FILLED ❑c. PRESSURIZED ❑d. UNDER VACUUM 490-29 490.3° PANEL MANUFACTURER., MODEL #: 'rLS 490-31 LEAK SENSOR MANUFACTURER y 49° 32 MODEL #(S): Z ® 490-33 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP (i.e., TURBINE) SHUTDOWN. ❑ a. YES ❑ b. NO 0-90-30- FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ 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 PRODUCT FLOW WHEN A LEAK IS DETECTED 23 CCR 263 490-36 MLLD MANUFACTURER(S): 490-37 MODEL #(S): 438 3. ELECTRONIC LINE LEAK DETECTOR (ELLD) THAT ROUTINELY PERFORMS 3.0 g.p h. LEAK TESTS (23 CCR §2636) 490-39 ELLD MANUFACTURER(S) %I e-9) f5 4 40' I MODEL #(S): R Lf gqgo -001 490-0-1 PROGRAMMED IN LINE LEAK TEST: ❑ 1. MINIMUM MONTHLY 0.2 g.p.h. ❑ 2. MINIMUM ANNUAL 0.1 g.p.h. 49042 ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a. YES ❑ b. NO 490.43 ELLD FAILURE/DISCONNECfION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a YES ❑ b. NO 490-44 ❑ 4. PIPE INTEGRITY TESTING 49o -4s TEST FREQUENCY Q a. ANNUALLY Q. b. EVERY 3 YEARS Q c. OTHERS i 49046 490.47 5. VISUAL PIPE MONITORING. 490-48 FREQUENCY ❑ a. DAILY ❑ b. WEEKLY ❑ C. MIN. MONTHLY & EACH TIME SYSTEM OPERATED* 490.49 • Allowed for nxndtoring of unburied enawor rud piping ordy per HSC 25281.5 3 ❑ 6. SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR §2636(ax3)1. 490-50 7. NO REGULATED PIPING PER HEALTH AND SAFETY CODE, DIVISION 20, CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM 49°-51 490.52 ❑ 99. OTHER (Specify) 490 53 UPCF UST -D (12/2007)1/4