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01/31/2008 THU 15:44 FAX 20433 SJC EHD
<br />/IrrWjroT A, 0002/010
<br />UNIFIED PROGRAM CONSOLIDATED FORM
<br />UNDERGROUND STORAGE TANK
<br />MONITORING PLAN - Pae 1 of 2)
<br />TYPE OF ACTION ❑ L NEW PLAN X 2. CLIANGF OF INFORMATION 4X''
<br />PLAN TYPE 1, MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILI'T'Y. 4904.
<br />(Check one item only) ❑ 2. THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S):
<br />I. FACILITY INFORMATION
<br />FACILITY 11) # (Agency Use Only)
<br />1-1.1
<br />1
<br />ITI
<br />I
<br />BUSINESS NAME (.Same as Facility Name or DBA)
<br />CAA,$/=OiZNsA dcGovja �i4t720L
<br />BUSINESS SITE ADDRESS 103.
<br />3330 ^! Aa 144J- 1?0, 4
<br />CITY 104.
<br />1 S oC1CM0 1
<br />H. EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE
<br />Testing, preventive maintenance, and calibration of monitoring equipment (e.g., sensors, probes, line leak detectors, etc.) must be performed at the frequency specified
<br />by ii.. ;v;p,,,eiit n,,,n,,fi,ctwcls' instnadions, or annually, whichever er is more frequent Such work must be performed. by qualified persolnael 123 ((R.§2632,26 34 26 8, 264,1
<br />_ -..
<br />490-3a.
<br />MONI 1 -KING EQUIPMENT IS SERVICED I. ANNUALLY ❑ 99.OTHER (Specify): 490.3b.
<br />III. MONITORING LOCATIONS
<br />PLO! I-LAN/MAP SUBMi I ILD WI t HI TiIS PLAN ❑ 2. SITZ: PLOT PLAN/MAP PREVIOUSLY SUBMI"1'ii-:D 123 ECR §2632, 2674) "�_4
<br />'I' AINK MONITORING IS PERFORMED USING THE FOLLOWING METHODS (Check all
<br />METHOD(S)
<br />that a ly
<br />i. t.'1 ,N'IINIIOUS ELECTRONIC TANK MONITORING OF ANNULAR (1NT'ERSNTiAL.) SPACE(S) OR SECONDARY CONTAINMENTVAULT'(S) 490-5.
<br />WI 111 AI IDIBLF. AND VISUAL. ALARMS. [23CCR§2632, 26341
<br />SECONDARY CONTAINMENT IIS:: Ela. DRY El b. LIQUID FILLED [3c. PRESSURIZED El d. UNDER VACUUM 490.6.
<br />PANEL MANUFACTURF,R: JEEO LI? R00 -r- 490-7' MODFI.. #: TLS - 350 490•8.
<br />I.FAK SENSOR MANUFAC'I'URf;R: 00041 OOrr 490-9 MODEL, #(S): 7911390 - IfZ 0 4'x1.10.
<br />❑ 2. A(II OMA TIC TANK GAUGINO( AT SYSTEM USED TO MONITOR SINGLE WALL. TANK(Q. 123 CCR §26431 490.11.
<br />PANEL MANUFACTURER; 490.12 MODEL#: 490.13"
<br />IN -YANK PROBE MANUFACTURER: 490.14. MODEL. #(S): 490.15
<br />LEAK TESTFRF.QUE:NCY: ❑ a. CONTINUOUS ❑ b. DAILY/NIGI-ITLY ❑ c. WEEKLY 490.1E
<br />❑ d. MONTHLY ❑ e. OT IIFR (Specify): 490.17.
<br />490.1x.
<br />1 ROul2AMML;D 11 STSEla 0.1 �.p_h. ❑ b 02g.ph. ©c 01ITFR(Specify)_ 40.19
<br />❑ 3. MON'] (ILY STATISTICAL INVENTORY RECONCILIATION 123CCRON4,11 490.20.
<br />------- ........... -- . ....
<br />------- --- -_ _ _..... _ ...... _.-.... ._....._
<br />❑ 4. W EEKLY MANUAL TANK GAUGING (MT[23 CCR §26451 TESTING PERIOD. ❑ a. 36 HOURS F_] b. 60 I IOU RS 4�� 21.
<br />..................... _....-..... _ _
<br />❑ 5. TANK INTEGRITY TESTING PER 123 CCR §264311 490-23.
<br />490-24.
<br />I I:S'f I RE QUGNCY ❑ a. ANNUALLY ❑ b. BIENNIALLY ❑ c OTHER (Specify)_90-26
<br />r
<br />_
<br />4•i(i-:. 1.
<br />V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) (Cit/iakw)
<br />I CONI INUOUS MONITORING OF PIPE/PIPING SUMP(S) AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE & VISUAL ALARMS. 490.28.
<br />1 2(3at SECONDARY CONTAINMENT is: 19 a. DRY [3b. LIQUID PILLET) ❑ c. PRESSURIZED [:1d. UNDER VACUUM 4)049'
<br />{n
<br />PANEL MANUFACTURER: vv" eg /COOT 490-30. MODEL #: TLS -:350 490'31.
<br />LI.AKSENSORMANUFACTURER: ER AfooT 490-32. MODEL #(s): 790 3ylo - 2O8 490-33.
<br />PIING LEAK ALARMTRIGGERS AUT'OMA'TIC PUMP (i.e., T'URBINF,) SHUTDOWN. C9 a. YES ❑ b. NO 491,34.
<br />I A 1I.1IRE/DISCONNECTION OF THE" MONI'T'ORING SYSTFM TRIGGFRS AUTOMATIC PUMP SHUTDOWN. ;R it. YES ❑ b. NO 49035-
<br />�1 -_ "1 i 1,.,.,-, ol"I.,-,(ncta•ILLi)) IHtii Kuliliivct.l 1106Pumvfz :3.0 g.p.h, LEAK tLSiS AND RES 1XR2I*S OR SIMIS OFF 4'tCi3o
<br />PKUTA CIFLOW WHEN A LEAK IS DFT'ECT' .123 CCR§26361
<br />MLLD MANUFACT'URER(S): f_4t perlio Sr -e 49°'37 MODEL #(S): 4VIL.0 ' 16 490.38.
<br />❑ 3. FLECTRONIC LINE TEAK DETECTOR (ELLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS.123 CCR§26361 490-39.
<br />1(111)MANUFACTURER(S): 490.40. MODEL#(S): 4904L
<br />i io ; .,JZAMNIED IN LINE LEAK'I'EST: ❑ a. MINIMUM MONI'I ILY 0.2 g.p.h. ❑ b. MINIMUM ANNUAL 0.1 g.p.h. 00'42,
<br />MLLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHU'T'DOWN. ❑ a- YES ❑ b. NO 490.43
<br />P1 1 D FAll.t IRF/DISCONNECt'ION'I'RIGGI-RS AUTOMATIC PUMP SHUTDOWN. ❑ a. YES ❑ b. NO 490'44
<br />❑ 4. PIPIT INTEGRITYTF.STING. •190.45.
<br />TEST' FREQUENCY: ❑ a. ANNUALLY [Ib. EVERY 3 YEARS El c. OTHER (Specify) 49<W7.
<br />❑ 5. VISUAL, PIPE, MONITORING. 410.4x.
<br />FREQUENCY: ❑ a. DAILY ❑ b: WEEKLY ❑ C. MIN. MONTTTLY & EACHTIM135YSTY'm OPERATED* 490.49
<br />._...,-._ „-,,.,,,,, ,--....,___,,,,,-•,,,_„-,•_.__.,,,._,,,.,.,,_-__,_!Altoprd for npnn9nng.,of unburied emcrgenc..�encnlor Cucl yilung9nl}ycrltSC, §232x1.5(bx7)_.
<br />❑ 6 SUCTION PIPING MEETS EXEMPTION CRITERIA. 123 CCR§2636(nT(3)1 490-30.
<br />❑ Z NO REEL II.ATED PIPING PER HEALTH AND SAFETY CODE, DIVISION 20, CRAP 11-,R 6.715 CONNECTED T'O TIIF TANK SYSTEM. 49f1.51.
<br />.. _ _ ..... ..... ._ . . _.. ....----._. ......... - __ ..W.....
<br />❑ ------------------..
<br />ii.52.99.OTTTER (Specify) 490.53.
<br />UPCF UST -D (12/2007) -114 www.uni(loes.org
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