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IFIED PROGRAM CONSOLIDATED FORMO
<br /> UNDERGROUND STORAGE TANK
<br /> MONITORING PLAN-LPage 1 of 2
<br /> TYPE OF ACTION ❑ 1.NEW PLAN ® 2.CHANGE OF INFORMATION 490-1
<br /> PLAN TYPE ® 1.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. 490-2
<br /> (Check one item only) ❑ 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S)7
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<br /> FACILITY ID#(Agency Use Only) iiiI 3NI I �.t
<br /> BUSINESS NAME(Same as FACILITY NAME) Tracy Blvd Shell #136186 3.
<br /> BUSINESS SITE ADDRESS 3725 N.Tracy Boulevard 1°3. CITY Tracy 104.
<br /> Testing,preventive maintenance,and calibration of monitoring equipment(e.g.,sensors,probes,line leak detectors,etc.)must be performed at the frequency
<br /> specified by the equipment manufacturers'instructions,or annually,whichever is more frequent,and that such work must be performed by qualified personnel.
<br /> 23 CCR 2632,2634,2638,2641
<br /> --- - - - -- ------- ---3a
<br /> MONITORING EQUIPMENT IS SERVICED ® 1.ANNUALLY El99.OTHER(Specify): 490-30-
<br /> P fY)� 490-36
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<br /> ®1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. ❑2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632,
<br /> 2634 904
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<br /> ® 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT 490-5
<br /> VAULT(S)WITH AUDIBLE AND VISUAL ALARMS. (23 CCR§2632,2634)
<br /> SECONDARY CONTAINMENT IS: ❑ a.DRY ® b.LIQUID FILLED ❑ c.PRESSURIZED ❑d.UNDER VACUUM -1906
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<br /> 490-7. j------------------------------------------------------------------- a9aa
<br /> PANEL MANUFACTURER_ - Veeder Root MODEL#: TLS-350R
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<br /> LEAK SENSOR MANUFACTURER: Veeder Root 490-9. MODEL#(S): 794380-301 490-10
<br /> ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).(23 CCR§2643) 490-11
<br /> PANEL MANUFACTURER: 490-12. MODEL#: 490-13
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<br /> IN-TANK PROBE MANUFACTURER: 49°la. MODEL#(S):
<br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------
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<br /> LEAK TEST FREQUENCY: ❑ a.CONTINUOUS El b.DAILY/NIGHTLY Elc.WEEKLY 490-16
<br /> ❑ d.MONTHLY ❑ e.OTHER(Specify): 490-17
<br /> --------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------Fl-
<br /> PROGRAMMED TESTS: ❑ a.0.1 h. ❑ b.0.2 h. ❑ c.OTHERS eci 490-19
<br /> g.p.h. g.p.h. (Specify): 490.19
<br /> ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 490-20
<br /> El 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§2645). TESTING PERIOD: E] a.36 HOURS E] b.60 HOURS 490.22
<br /> ❑ 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 490•23
<br /> TEST FREQUENCY: ❑ a.ANNUALLY E] b.BIENNIALLY Elc.OTHER490-245(Specify): 490-2 5
<br /> ®99.OTHER (Specify): Simplicity 490-26
<br /> 490-27
<br /> V.PIPE MUNOR]Ct'+'I IS PERFUR1)USING THByFOI n, WINiET ( ?(S),(Geck allfithat agly) ' t
<br /> ® 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 490-28
<br /> VISUAL ALARMS. (23 CCR§2636)
<br /> SECONDARY CONTAINMENT IS:®a.DRY [1b.LIQUID FILLED ❑c.PRESSURIZED ❑d.UNDER VACUUM -19029
<br /> --------------------------------------------------------------- ------------------------------------------ -------i ------------------------------------------------
<br /> - PANEL MANUFACTURER: Veeder Root 490 30 i MODEL#: TLS-350R 490-31
<br /> ---------- ------------------------------------------------
<br /> _-_ - -- -
<br /> LEAK SENSOR MANUFACTURER: Veeder Root 490.32 --MODEL#(S): 794380-208,-352_ 490-33
<br /> ---------- ------------------------------------------------------ -------------- -
<br /> PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. ®a.YES [Ib.NO 490-34
<br /> FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ®a.YES ❑b.NO 490.35
<br /> ❑ 2.MECHANICAL LINE LEAK DETECTOR(MLLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS AND RESTRICTS OR SHUTS OFF
<br /> PRODUCT FLOW WHEN A LEAK IS DETECTED 23 CCR 2636 490.36
<br /> MLLD MANUFACTURER(S): 490-37 MODEL#(S): 490-35
<br /> ® 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS (23 CCR§2636) 490.39
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<br /> ELLD MANUFACTURER(S) Veeder Root_ 49040. �I MODEL#(S)_ ELLD 49041
<br /> PROGRAMMED IN LINE LEAK TEST: ❑ I.MINIMUM MONTHLY 0.2 g.p.h. [12.MINIMUM ANNUAL 0.1 g.p.h. ago-az
<br /> ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑x a.YES ❑b.NO 49043
<br /> ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. El a.YES ❑b.NO 49044
<br /> ❑ 4.PIPE INTEGRITY TESTING 49o45
<br /> TEST FREQUENCY ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(Specify) 490-46 49047
<br /> ❑ 5.VISUAL PIPE MONITORING. 49048
<br /> FREQUENCY ❑ a.DAILY ❑ b.WEEKLY ❑c.MIN.MONTHLY&EACH TIME SYSTEM OPERATED* 490-49
<br /> 'Allowed for monitorin of unburied emergency enerator fuel piping only per HSC§25281.5(b)(3)
<br /> ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR§2636(a)(3)]. 490-50
<br /> ❑ 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM
<br /> 490-51
<br /> ❑ 99.OTHER(Specify) 490-52
<br /> 490.53
<br /> UST Response Plan(3/2008)3/3
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