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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN-(Page 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(S): I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) t. BUSINESS NAME(Same as Facility Name or DBA) 3. Chevron Station#96171 BUSINESS SITE ADDRESS 6633 Pacific Ave 103. 1 CITY Stockton,CA 95207 104 II. 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.Such work must be performed by qualified personnel.[23 CCR§2632,2634,2638,26411 MONITORING EQUIPMENT IS SERVICED ® 1.ANNUALLY ❑ 99.OTHER(Specify): 490--3b. IH. MONITORING LOCATIONS ❑ 1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN ❑ 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED [23 CCR§2632,26341 490-4, IV. TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) 111at 1l) 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) 490-5. WITH AUDIBLE AND VISUAL ALARMS.[23 CCR§2632,26341 SECONDARY CONTAINMENT IS: ® a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED ❑ d.UNDER VACUUM 490.6. PANEL MANUFACTURER: Veeder-Root 490-7. MODEL#: TLS-350 490-8. LEAK SENSOR MANUFACTURER: Veeder-Root 4490 MODEL#(S): Liauid Sensor Series 794380409 490-10. ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).[23 CCR§26431 490-11. PANEL MANUFACTURER 490-12. MODEL#: 490-13. IN-TANK PROBE MANUFACTURER: 490.14. MODEL#(S). 490-15. LEAK TEST FREQUENCY: ❑ a.CONTINUOUS U b.DAILY/NIGHTLY U a WEEKLY 490-16. ❑ d.MONTHLY ❑ e.OTHER(Specify): 490-17. PROGRAMMED TESTS: a.0.1 h. b.0.2 h. c.OTHER499. ❑ S•P ❑ g�P� ❑ _(Specify): 490-19. ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION[23 CCR§2646.11 490-20. ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)[23 CCR§26451 TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS a9azr. _ a90-zz. ❑ 5.TANK INTEGRITY TESTING PER 123 CCR§2643.11 490-23. TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): 49092552x. ❑ 99.OTHER(Specify): ----- _-- - 49090-26. 27. V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) 1 shack a" ® 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE&VISUAL ALARMS. 490-28. [23 CCR SECONDARY CONTAINMENT IS: ® a.DRY ❑ b.LIQUID FILLED [3c.PRESSURIZED ❑ d.UNDER VACUUM 490-29. PANEL MANUFACTURER:Veeder-Root 490-30. MODEL#: TLS-350 490-31. LEAK SENSOR MANUFACTURER: Veeder-Root 490-32. MODEL#(S): 352(turbine sumo)&208(nu sumps) 490-33. 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. --O--i.-MECHANICAL LINE LEAK DETECTOR(MLLD)THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS AND RESTRICTS OR SHUTS OFF 490-36. PRODUCT FLOW WHEN A LEAK IS DETECTED.[23 CCR§26361 MLLD MANUFACTURER(S): 490-37 MODEL#(S): 490-38. ® 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS.[23 CCR§26361 490-39. ELLD MANUFACTURER(S):Veeder-Root 49040. MODEL#(S):PLLD Series 848480-003 49041. PROGRAMMED IN LINE LEAK TEST: ❑ a.MINIMUM MONTHLY 0.2 g.p.h. ❑ b.MINIMUM ANNUAL 0.1 g.p.h. 49042. 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 490-44. ❑ 4.PIPE INTEGRITY TESTING. 49045. TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(Specify) 4404-477. ❑ 5.VISUAL PIPE MONITORING. 49048. FREQUENCY: ❑ a.DAILY ❑ b.WEEKLY ❑ c.MIN.MONTHLY&EACH TIME SYSTEM OPERATED' 49049. •Allowed for matitoring of unburied emergency generator fuel Pipingonly per HSC§25281.5(6x3) ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA.123 CCR§2636(a)(3)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. 0 99.OTHER(Specify) 49 52. 053