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• UNDERGROUND STORAGE TANK MONITORING PLAN ►' For use by(!nidocs Member Agencies or where approved by your Local Jurisdiction . Authority Cited: Title 23 CCR,Sections 2632(d)(1),2634(d)(2),and 2641(h) TYPE OF ACTION ❑ 1.NEW PLAN ❑ 2.CHANGE OF INFORMATION Mol. PLAN TYPE A MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. M02. (Check one item only) ❑ THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): I. FACILITY INFbRMATION id tlx �" t fN T Y FACILITY ID#(Agency Use Only) 77 t� T 1 Ejh} FACILITY NAME M03 FACILITY SITE ADDRESSIS.��'t,/; 1 Inti CITY (' �1 MOS. II. EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE State law requires that testing,preventive maintenance,and calibration of monitoring equipment(e.g.,sensors,probes,line leak detectors,etc.)be performed in M06 accordance with the equipment manufacturers'instructions,or annually,whichever is more frequent. Such work must be performed by qualified personnel. MONITORING EQUIPMENT IS SERVICED 1.ANNUALLY Mol. ❑ 99.OTHER(Specify): III. MONITORING LOCATIONS This monitoring plan must include a Site Plan showing the general tank and piping layouts and the locations where monitoring is performed(i.e.,location of each sensor, line leak detector,monitoring system control panel,etc.). If you already have a diagram(e.g.,current UST Monitoring Site Plan from a Monitoring System Certification form,Hazardous Materials Business Plan map,etc.)which shows all required information,include it with this plan. IV* TANK MONITORING MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S):(Check all that apply) M10 ❑ I.CONTINUOUS ELECTRONIC MONITORINQ OF TANK ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) SECONDARY CONTAINMENT/1S: .a.DRY El b.LIQUID FILLED ❑ c.UNDER PRESSURE d.UNDER VACUUM Mn. PANEL MANUFACTURER: If c.-Coc IZ.OIJT M12. MODEL#: TU MI3. LEAK SENSOR MANUFACTURER: n( ,A ip"CcT M14. MODEL#(S): ry I (O M15 ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S) PANEL MANUFACTURER: I/�L�f=p�/J /LQ8% MI6. MODEL#: I=oy M17. IN-TANK PROBE MANUFACTURER:7L) ✓Gc y' Mia MODEL#(S): '(,{q MM LEAK TEST FREQUENCY: a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY I M d.MONTHLY ❑ e.OTHERM21 (Specify): PROGRAMMED TESTS: ❑ a.0.1 g.p.h. ❑ b.0.2 g.p.h. ❑ c.OTHER(Specify): M22. M23. ❑ 3.INVENTORY RECONCILIATION ❑ a.MANUAL PER 23 CCR§2646 b.STATISTICAL PER 23 CCR§2646.1 M24. ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)PER 23 CCR§2645 TESTING PERIOD: ❑ a.36 HOURS b.60 HOURS M25. ❑ 5.INTEGRITY TESTING PER 23 CCR§2643.1 TEST FREQUENCY: a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): M26 M27. ❑ 6.VISUAL MONITORING DONE: a.DAILY ❑ b.WEEKLY(Requires agency approval) ❑ 99.OTHER(Specify): Meg. V. PIPE MONITORING MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) Mao. 1.CONTINUOUS ELECTRONIC MONITORING OF PIPING SUMP(S)/TRENCH(ES)AND OTHER SECONDARY CONTAINMENT SECONDARY CONTAINMENT IS: � a.DRY ❑ b.LIQUID FILLED ❑ c.UNDER PRESSURE ❑ d.UNDER VACUUM M31. PANEL MANUFACTURER: M32 MODEL#: jru M33 LEAK SENSOR MANUFACTURER: ItL4-) Jjx./t CST M" MODEL#(S): X' M35. WILL A PIPING LEAK ALARM TRIGGER AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN? a.YES ❑ b.NO M36. WILL FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWIS a.YES [Ib.NO M37. 2.MECHANICAL LINE LEAK DETECTOR (MLLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS ANDRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK IS OETECTE-7D�,, MLLD MANUFACTURER(s): Lfl Owls r Mag. MODEL#(S): X C.-p M39 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS ELLD MANUFACTURER: ACC 0)3C,/(LZT M40. ODEL#: X 1_,/� M41. PROGRAMMED LINE INTEGRITY TESTS: Ela.MINIMUM MONTHLY 0.2 g.p.h. b.MINIMUM ANNUAL 0.1 g.p.h. M42. WILL ELLD DETECTION OF A PIPING LEAK TRIGGER AUTOMATIC PUMP SHUTDOWN? a.YES ❑ b.NO M43. WILL ELLD FAILURE/DISCONNECTION TRIGGER AUTOMATIC PUMP SHUTDOWN? a.YES ❑ b.NO M44 4.INTEGRITY TESTING TEST FREQUENCY: a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(Specify) M45. M46. 5.VISUAL MONITORING DONE: a.DAILY ❑ b.WEEKLY* ❑ C.MIN.MONTHLY&EACH TIME SYSTEM OPERATED** M47. *Requires agency approval **Allo%ed for monitoring of unburied emergency generator fuel piping onh.per HSC§25281.5(6)(3) 6.PIPING IS SUCTION PIPING MEETING ALL REQUIREMENTS FOR EXEMPTION FROM MONITORING PER 23 CCR§2636(a)(3) ❑ 7.NO PRODUCT OR REMOTE FILL PIPING IS CONNECTED TO THE UST(s) ❑ 99.OTHER(Specify) M48 UN-022A-1/5 www.unidocs.org Rev.10/14/03