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e 111 STA 161 C A [E tj jj'-111 UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN - (Page 1 of 2) TYPE OF ACTION ❑ 1. NEW PLAN fJ 2. CHANGE OF INFORMATION 490-1 PLAN TYPE ❑ 1. MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. 490-2 (Check one item only) THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S)- . I. -FAC 6 INFORMATION - FACILITY ID # (Agency Use Only) BUSINESS NAME (Same as FACILITY NAME) 3. BUSINESS SITE ADDRESS .e - . 103. LtS?Gte CITY 104. -� P�TIJe o IIEta P G EN CE _. Testing, preventive maimenance, and calibration of monitoring equipment (e.g., sensors, probes, tine leak detectors, etc.) must be performed at the frequency specified b the pec y 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 ❑ 99. OTHER (�1�)' 490-3b 490-3S b . MOP"01UNG LWATIONS ❑ 1. NEW SITE PLOT PLANMAP SUBMITTED WITH THIS PLAN. ❑ 2 PLOT PLANMAP PREVIOUSLY SUBMITTED. (23 CCR §2632, 2634)49o-4 IV. TANKMOMT01MG IS PERFOWAMUSING TM FOLLOVANG OD( ) , CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR RSTITIAL) SPACE(S) OR SECONDARY CONTAINMENT 490.5 VAULT(S) WITH AUDIBLE AND VISUAL ALARMS. (23 CCR §2632,2634) SECONDARY CONTAINMENT IS: �ra. DRY ❑ b. LIQUID FILLED ❑ c. PRESSURIZED ❑ d. UNDER VACUUM 490-6 PANEL MANUFACTURER: 41. MODEL M M:5-2000 490-8 LEAK SENSOR MANUFACTURER: 490 -9 -MODEL #(S)!OD'© 490-10 2. AUTOMATIC TANK GAUGING (ATG) SYSTEM USED TO MO OR SINGLE WALL TANK(SI. (23 CCR §2643) 490.11 PANEL MANUFACTURER: 490.11 MODEL #: 490-13 IN -TANK PROBE MANUFACTURER: 490-14. 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): 490-18 490-18 ❑ 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 ❑ b. 60 HOURS 490-21 490-22 El 5. TANK INTEGRITY TESTING (23 CCR §2643.1): 490-23 TEST FREQUENCY: ❑ a. ANNUALLY ❑ b. BIENNIALLY ❑ c. OTHER (Specify): 490-24 490-25 ❑ 99. OTHER (Specify): 490-26 490-27 V. P1PKM0Nff01MG IS PERFORMD USING TM FOUDWMG (S) (Check all that a ly) El 1. CONTINUOUS MONITORING OF PIPE/PIPINGS (S) AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 490.28 UAL ALARMS. (23 CCR §2636) SECONDARY CONTAINMENT IS: . DRY ❑b. LIQUID FILLED ❑c. PRESSURIZED ❑d UNDER VACUUM 49x29 PANEL ACTURER490-30 MODEL #: /YrS ®J 490-31 LEAK SENSOR MANUFACTURER: L-)qelA JA&.tL4C&490-32 MODEL #(S): L g> V> 490-33 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP (i.e., TURBINE) SHUTDOWN. ❑ a. YES ❑ b. NO 490-34 FAILUREMISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a. YES ❑ b. NO -MECHANICAL 490-35 2. LINE LEAK DETECTOR (MLLD) THAT ROUTINELY PERFORMS 3.0 gp h. LEAK TESTS AND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK IS DETECTED 23 CCR IMN 490-36 MLLD MANUFACTURER(S): 490-37 MODEL #(S): 490.38 ❑ 3. ELECTRONIC LINE LEAK DETECTOR (ELLD) THAT ROUTINELY PERFORMS 3.0 gph. LEAK TESTS (23 CCR §2636) 490.39 ELLD MANUFACTURER(S) " MODEL #(S): 49041 PROGRAMMED IN LINE 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 490-43 ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a. YES ❑ b. NO 490.44 4. PIPE INTEGRITY TESTING 49o-45 TEST FREQUENCY a. ANNUALLY b. EVERY 3 YEARS c. OTHERS 1 490.4649047 5. VISUAL PIPE MONITORING. 49048 FREQUENCY ❑ a. DAILY ❑ b. WEEKLY ❑ C. MIN. MONTHLY & EACH TIME SYSTEM OPERATED• 49049 * Allowed for rnomoog of unburiedmergency enera or fuel gipinS only HSC 25281. 3 ❑ 6. SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR § aR3)1. 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 49(1 53 111 STA 161 C A [E tj jj'-111