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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( I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) - BUSINESS NAME(Same as FACILITY NAME) Tracy Blvd Shell 3_ BUSINESS SITE ADDRESS 3725 N.Tracy Boulevard 103. CITY Tracy 104" U.EQUIPMENT TESTING 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 equipment manufacturers'instructions,or annually,whichever is more frequent,and that such work must be performed by qualified personnel. (23 CCR X2632,2634L 26383 2641)__ MONITORING EQUIPMENT IS SERVICED ® 1.ANNUALLY F-199.OTHER(Specify): 490-3 S eci 490-3b b III.MONITORING LOCATIONS ®1.NEW SITE PLOT PLANIMAP SUBMITTED WITH THIS PLAN. ❑2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 2634)490-4 IV.TANK MONITORING'IS PERFORMED USING THE FOLLOWING:METHOD(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: ❑ a.DRY ® b.LIQUID FILLED ❑ c.PRESSURIZED ❑d.UNDER VACUUM ---------------49D-6 -__ PANEL MANUFACTURER_-- Veeder Root MODEL#: TLS-350R 4904. 4945 ---- -- -- - - - .......-------------------- _ _ -... -_ -- - - ------------ LEAK SENSOR MANUFACTURER: Vecdcr Root 4"0-9. 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): 49-15 LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY 49046 ❑ d.MONTHLY ❑ e.OTHER(Specify): 490.17 --- --- -- -- - - --- - - - - --- - ------------------------------------ -- __ PROGRAMMED TESTS: ❑ a.0.1 h. ❑ b.0.2 h. ❑ c.OTHER(Specify): 490-18 g.p. g.p.h, ( P y)' 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 [Ib.60 I IOURS 490.22 ❑ 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 490.23 TEST FREQUENCY: E] a.ANNUALLY El b.BIENNIALLY ❑ c.OTHER(Specify): 490-25 490.26 ®99,OTHER (Specify): SirrtpliCitY 490.27 V.PIPE MONITORING IS PERFORMED-USING THE FOLLOWING METHOD(S),(Check all that apply) 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 490.28 VISUAL ALARMS. (23 CCR§2636) SECONDARY CONTAINMENT IS:®a.DRY ❑b.LIQUID FILLED ❑c.PRESSURIZED ❑d.UNDER VACUUM 490-29 ----------__..-__�_T_ ------ ___..__--_-_---______ ___-------- A90.30 490.31 - -PANEL MANUFACTURER: - - Veeder Root-� _ -- ___-__- _ _ ___MODEL#_ TLS-3508 ..... -490 32 490.73 _ LEAK SENSOR MANUFACTURER: Veeder Root �- _ �- MODEL#(S): 7943800208 - 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 ❑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)A23 CCR_1263 -� 49D.36 MLLD MANUFACTURER(S): 49°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 -_- - - -_ _ - _--------------- - - _9- _ 490A0. 490-41 - ELLD MANUFACTURERS) Veeder Root- - _- - - - _ MODEL#(S)_ PLLD -_ _ - - PROGRAMMED IN LM LEAK TEST: ❑ 1.MINIMUM MONTHLY 0.2 g.p.h. ❑ 2.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 49-44 4,PIPE INTEGRITY TESTING 490.45 TEST FREQUENCY ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(Specify) 4904649047 5.VISUAL PIPE MONITORING. 490"48 FREQUENCY ❑ a.DAILY ❑ b.WEEKLY ❑c.MIN.MONTHLY&EACH TIME SYSTEM OPERATED* 490.49 •Aaowed for monitoring ofunburied emergency enerator Poet piping only per HSC 25281.5 ❑ 6,SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR§2636(x)(3)]. 490-50 ❑ 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM 490-51 490.52 ❑ 99.OTHER(Specify) 490-53 UST Response Plan(3/2008)3/3