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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 PLAN COVERS ONLY THE FOLLOWING UST SYSTEM($) $.,�)�'ACILITY'INFOIZMATION ; ,; FACILITY ID#(Agency Use Only) - I ` BUSINESS NAME(Same as FACILITY NAME) Shell&Mini Mart # 136186 3. BUSINESS SITE ADDRESS 3725 N.Tracy Boulevard 103. CITY Tracy 104. 777 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 - _ _ - --- - -__ -- - -- ____ - - ---3a MONITORING EQUIPMENT IS SERVICED ® 1.ANNUALLY El99.OTHER S eci 490-3a ❑1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. ®2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 2634 4904 IVB '00 1. T .FZ3LLOWIIG,ME7' ,D(S II ,ix.t,7 Fl�ii',;'III,i i.,l, ��.. k ® 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 El c.PRESSURIZED F-1-d.-_UNDER-VACUUM 490-6 __________________-_______--_____ ________________-_____-___________ PANEL MANUFACTURER: Veeder Root a9°-7. i MODEL#: TLS-3508------------- 4948 ----------------------------------------------------------------------------------------------------------------------- MODEL#: LEAK SENSOR MANUFACTURER: Veeder Root ago-9. MODEL#(S): 794380-301 490-10 ❑ 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: 490-14. MODEL#(S): a901s ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ C.WEEKLY 490-16 ❑ d.MONTHLY ❑ e.OTHER(Specify): 490-17 ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------18 PROGRAMMED TESTS: ❑ a.0.1 h. ❑ b.0.2 h. ❑ c.OTHER490-18 g•P• g•P• (Specify): 490-19 ❑ 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 490-21 go zz ❑ 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 490-23 FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHERS eci 490-z4 TEST FRE Q (Specify): 490-25 ®99.OTHER (Specify): SimpliCity 490-26 490.27 .,,. Q. ,'f FttLT.(} ICN{3r METH( 5}(Clk all t�' I; Pply} ® 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND ago-ia VISUAL ALARMS. (23 CCR§2636) SECONDARY CONTAINMENT IS:®a.DRY ❑b.LIQUID FILLED ❑c.PRESSURIZED ❑d.UNDER VACUUM 490-29 ------------ - - -- - - -- - -- -_ -----• - -- - 490-30 490-31 -PANEL MANUFACTURER: Veeder Root MODEL#: TLS-350R 490-32 490-33 LEAK SENSOR MANUFACTURER: Veeder Root 1 MODEL#(S)_ 794380-208 490-34 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. ®a.YES ❑b.NO 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.p.h.LEAK TESTS AND RESTRICTS OR SHUTS OFF - PRODUCT FLOW WHEN A LEAK IS DETECTED(23 CCR§2636) 490-36 MLLD MANUFACTURER(S): ago-37 MODEL#(S): 490-38 ® 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS (23 CCR§2636) 490-39 49040. 490-41 E[[6-Ki ACTURERS) Veeder Root 1; MODEL#(S): 8484 -------------------------- - ----------------------------------------------------- ---- - ------------------------------------------ -- - ------- --------------------------------------------------- -- PROGRAMMED IN LINE LEAK TEST: []--I-.-MINIMUM-MONTHLY 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. 0 a.YES ❑b.NO 49043 ELLD FAILUREMISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ®a.YES ❑b.NO 490-44 ❑ 4.PIPE INTEGRITY TESTING 49045 TEST FREQUENCY ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(Specify) 49046 49047 ❑ 5.VISUAL PIPE MONITORING. 49048 FREQUENCY ❑ a.DAILY ❑ b.WEEKLY ❑c.MIN.MONTHLY&EACH TIME SYSTEM OPERATED* 49049 *Allowed for monitoring of unburied emergency enerator fuel piping only per HSC§25281.5(b)(3 ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA[23 CCR§2636(a)(3)]. 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)1/5