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UNIFIED PROGRAM CONSOLIDATED FORM
<br /> UNDERGROUND STORAGE TANK
<br /> MONITORING PLAN--(Page I ®f;
<br /> AIR-1.
<br /> t'YPr.OF ACTION ❑ 1.NEW PLAN 2 CHANGE 01'INFORMATE()N
<br /> PLAN TVPI-: gi 1,MONITOPING IS IDFNI iC'AI HYIR ALL I JSTs AT THIS FACILITY. 4•�2.
<br /> (Check one item only:) ❑ 2.1 HIS PIAN COVERS ONLY THE FOLLOWING UST SYSTEM(S):
<br /> I. FACILITY INFORMATION
<br /> FAC:ILI'fY LU#(Ab��a'y U.ce nrrivl
<br /> BUSINESS NAME(Came as/•'deitity Name.or DP.9)
<br /> I)USINFSS SITE.ADDRESS / / l Itr3�.(C[
<br /> bf/PR. Fre e�'�v,,1 T . �lCIL'T�'e7 ��131 `C
<br /> Ii. EQUIPMENT TES"t'ING AND PREVENTIVE MAINTENANCE
<br /> 'Rating,preventive maintenunce_and calibration of monitoring equipment(e.g.,unsurs,probEs,liltc Icak detectors,etc.)must be performed at the frequency specified
<br /> tt)e ui men!manu(hcturers'instructions or annut:lly,whiti:hever is more frequent.Such work must he crlbrmcd by quz.lified rstmncl les cC1<4a<,39,?b3A.263R.264II
<br /> _ AW1-3a.
<br /> MONITORING L'(?UtPMI?NT IS%EPVICL:I1 Pj I ANNUALLY _ rl 99.O1 NLK(Soocifv): axr to
<br /> M. MONITORING LOCATIONS
<br /> ❑ 1.NLW SI'Z'E PLOT PIAN/MAP SUBMITTrn WITH THIS PLAN J$ 2.SITF PI,OT PLAN/MAY PRLiVIOUSI.Y S[JBMIT-I'ED 123CCR4'LR31 mum
<br /> IV. TANK MONI`TO G IS PERFORMED USING THE FOLLOWING METHODS) h,',`k 1l)
<br /> I,CONTINUOUS LLL;CTRONIC TANK MON ITOKING OF ANN[JLAR(IN'TERSTIT(A(,)SPACF.(S)OR SECONDARY CONTAINMENT VAUL.'C(S)
<br /> WITH AUDIBLE AND VISUAL ALARMS.123 CCR§xe32,26341
<br /> SECONDARY CONTAINMENT IS: a DRY U b1 L[QUID FILLED El c,VKUI Z UR17Ab[J E] d.UNDER VACUUM
<br /> PANELMANUFACtURER. for 4wri. MODFI,#: L X50
<br /> AA 40,ry
<br /> LEAK SENSOR MANUFACI'UKER: Ve e, t/ 12, $CE #( ): d Kr IR.
<br /> ❑ 2.AUTOMAT[(:TANK:0AIJGIN6(A'T(i)SY:jTFM IJ1k1J IU MUNI IOK SIN(-ti.F.WALL TANK{S).I23 ct:K*z(r+q
<br /> PANet.MAN(JFACFURLR: 4.x"12 MODEL#: 4ati1J'
<br /> IN-TANK PROBE MANUFACI REK. 4'x.44' MODE L#IS):
<br /> I.FAK TL5'r IMCQUENC'S'. a.CONTINUOUS ❑ b.OA[I.vn IIGN'rl Y ❑ c.WF,F.ICLY itk Ib.
<br /> 4'X)-L7.
<br /> ❑ d.MC)NTHLY ❑ c.OTHER(Specify):
<br /> PRO(?RAMMED 11i5'CS. .... C. -
<br /> ❑ S.MUNIHLY SlA((STIR.AL INVENTOKY KLCC)SC:ILIATION Is,1.t.xQ_wa;.s1 43412°
<br /> ❑ 4.WEEKI,Y MANUAL TANK GAUGING(MTG)123 Co.JwAsl TESTING PERIOD: ❑ a.36 HOURS El b,f0 H(1IJRS 4-X°-22
<br /> _ __...,......_._. .,.. ................. --- ....,
<br /> ❑ S.'TANK LNTCGRITYTES'i'1N(iPLR123CCR§2/,,4111
<br /> TEST MEQUENCY: U a.ANNUALLY ❑ b.LIIISNNIALLY C.U I HhK.IS 011)1); 41n as2�'_
<br /> ❑ 99,OTHER(Specify):
<br /> eckal
<br /> V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD ;k,w /1
<br /> 50 1,CONTINUOUS MONITORING OF PIPLJPIPING SUMP(S)AND O"L'HLiK SECONDARY('ON'TAINMENT WITI I AIfDIBLE&VISUAL ALARMS.
<br /> 11
<br /> "CK SECONDARY CONTAINMENT IS: Rf a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURI7,FD ❑ d.UNDRR VACUUM 4��I eil /
<br /> PANL'L MANIJFACTIJREK. (6.34.✓ x—,0014- t ;R MOD17.1.A: p 4900 1
<br /> 4,m-32
<br /> LEAK SENSOR MANUFACTURER: MODEL#(S): '79!!1 so—A074711.33.
<br /> PIPING LEAK ALA RM'TRIGGERS AU'T'OMATIC PUMP(i.c.,TURBINE)SI IUTDOWN. ® a.YES ❑ b.NO 41AI-14
<br /> I:AILURC/DISC.ONNECTION OF'I'HF;MC)NrrORING SYSTEM TRIO SRS AUTOMATIC PUMP 9JI[.1TTI0WN a YRS_❑ b.NO 490-35
<br /> ❑ 2.MECHANICAL LINF.I,FAK DETE.CI.OR(MLLDD THAT ROUT-INELY PLRrORMS:3.0 S.p,h. LEAK TLSTS AND RF,STRIC'TS OR SHUTS OFF 490-36
<br /> PRODUCT I'F(,OW WHEN A LL•:AK IS 0(,'TF.CTrD. 23(TR42(,3e1 a7a17 ® x>o1e
<br /> MI,I,D MANIJFAC I'URIiR(S): /��Ip'Y�t y MODEL#(S): g�� 'r/ �D
<br /> ❑ 3�I(I,I'd."I'it<)NICLINt:LTiAI�r)i:l'fiC:Tt)R(FLLU)'1'tiA'1 }�(�ItITINRI.YPIiRI't)ItMti7.0 h.l.l�AlC'�>rST$.t=+(aa1{i3n3h1 •;�3y...
<br /> E p•
<br /> F,I.I.D MANUFAC"I'UKL TOS): �( MODEI.#(S): M-41.
<br /> PROGRAMMED IN LINK LEAK.TEST: ❑ a.MINIMUM MONTHLY 0.2 g.p.h. ❑ b.MINIMIJM ANNUAL 0.1 g.p.h. 4%"Z
<br /> ELLD Dki`'C-C'L•!ON OF A PIPING LEAK fR(Ct:,F.RS AUTOMATIC PUMP SHUTDOWN L( a.YES ❑ b.NO '""'-4'-
<br /> L.LLD FAIL.IIRFIDISC ONNI:C'I'ION'rRiCiCiF.RS AUTOMATIC PUMP SI IU`L DOWN. a.YI:S ❑ b.NO 4'x4
<br /> Q 4.PIPE:IN'TGGR.ITY TFSTIN(i.
<br /> TEST FREQIIi?NCY: ❑ a ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.O"1"EIER(S�cCi ) 4hr47.
<br /> _.......__............. S.,
<br /> .. 490,4IS.
<br /> ❑ 5. VISUAL PIPE.MONTfORING.
<br /> FREQUENCY: F1 a.DAILY b.wF.riKI.Y ® C.MIN.MONTHLY&rACII TIME SYS'I'Em 0PERATFD' 4341)49.
<br /> .Nw,•,4 r,:.,
<br /> ._,....,.,_.. ,.. ,. ..._.,._,...___...__.................. ..,....._....,._..,,.._-_.........._...... .
<br /> ❑ b.SUC ION PIPING MEETS EXEMPTION CKITVJLlA 121('CR§26WAX3)1 Ova
<br /> Cl 7.No RftCeIJI.ATFD PIPING ftR I(I;Al,I'l I AND SAFFTY CODE,DIVISION 20,CIIAP F.R 6 7 IS CONNECTF13 TO'THL TANK SYSTEM. kny51.
<br /> ❑ 99,e7Tnrn(s�;tty) .., -. 1hW 53.
<br /> VPCF UST-D(12/2007)-I/4 www.uridev.s.org
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