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r SAN JOA COUNTY ENVIRONMENTAL HEALTH ARTMENT <br /> UNDERGROUND STORAGE TANK <br /> ONITO N-PAGE I <br /> 11 111I Mol. <br /> TYPE OF ACTION >. I.NEW PLAN ❑ 2.CHANGE OF INFORMATION <br /> Moe. <br /> PLAN TYPE ® MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. <br /> (Check one item only) ❑ THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): <br /> L FACILITY INFORMATION <br /> FACILITY M#(Agency Use Only) <br /> M03. <br /> FACILITY NAME <br /> FACILITY SITE ADDRESS CITY f Mos. <br /> H. EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE <br /> State law inquires that testing,preventive maintenance,and calibration of monitoring equipment(e.g.,sensors,probes,line leak detectors,etc.)be performed in M06 <br /> accordance with the equipment manufacturers'instructions,or annually,whichever is more frequent. Such work must be performed by qualified personnel. <br /> Mol. <br /> MONITORING EQUIPMENT IS SERVICED 1.ANNUALLY ❑ 99.OTHER(Specify): <br /> III. MONITORING LOCATIONS <br /> 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, <br /> 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 <br /> form,Hazardous Materials Business Plan map,etc.)which shows all required information,include it with this plan. <br /> IV. TANK MONITORING <br /> MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S):(Check all that apply) M10. <br /> 1.CONTINUOUS ELECTRONIC MONITORING OF TANK ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) <br /> SECONDARY CONTAINMENT ISS''Q® a.DRY ❑ b.LIQUID FILLED ❑ c.UNDER PRESSURE [:] d.UNDER VACUUM ,,�Mnt' <br /> PANEL MANUFACTURER: I "3350 M12 MODEL#: O•-420V F(W11 ISI' <br /> LEAK SENSOR MANUFACTURER: VIED 6P QQJT" M14. MODEL#(S): ALL.3 M15. <br /> ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S) <br /> PANEL MANUFACTURER: M16. MODEL#: M12. <br /> IN-TANK PROBE MANUFACTURER: M11' MODEL#(S): M19. <br /> LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY M20. <br /> ❑ d.MONTHLY El e.OTHER(Specify): M21. <br /> PROGRAMMED TESTS: [I a.0.1 g.p h. ❑ b.02 g p.h. El c.OTHER(Specify): M22. M23. <br /> ❑ 3.INVENTORY RECONCILIATION [I a.MANUAL PER 23 CCR§2646 ❑ b.STATISTICAL PER 23 CCR§2646.1 M24. <br /> ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)PER 23 CCR§2645 <br /> TESTING PERIOD: Ela.36 HOURS ❑ b.60 HOURS Mzs. <br /> ❑ 5.INTEGRITY TESTING PER 23 CCR§2643.1 <br /> TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): Mz6. Mn. <br /> ❑ &VISUAL MONITORING DONE: ❑ a DAILY ❑ b.WEEKLY(Rcyu-ag=y approval) <br /> Mzx. <br /> ❑ <br /> 99-OTHER(Specify): <br /> V. PIPE MONITORING <br /> MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) M30' <br /> 1.CONTINUOUS ELECTRONIC MONITORING OF PIPING SUMP(S)/TRENCH(ES)AND OTHER SECONDARY CONTAINMENT3jMP <br /> SECONDARY CONTAINMENT IS: 14 a.DRY ❑ b.LIQUID FILLED ❑ c.UNDER PRESSURE ❑ d.UNDER VACUUM M31. <br /> PANEL MANUFACTURER: TQ 3S;3 M32. MODEL#:h7- Q79 3 I1Q-U8 Mm3. <br /> l LEAK SENSOR MANUFACTURER: Mia. MODEL#(S) `! J`RY�7( M35. <br /> WILL A PIPING LEAK ALARM TRIGGER AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN? ❑ a.YES ❑ b.NO M36. <br /> WILL FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? ❑ a.YES ❑ b.NO M37. <br /> MECHANICAL LINE LEAK DETECTOR (MLLD) THAT ROUTINELY PERFORMS 3.0 g.p h. LEAK TESTS AND RESTRICT'OR SHUTO�F�F <br /> PRODUCT FLOW WHEN A LEAK IS DETECTED Diji_ ` 2 <br /> MLLD MANUFACTURER(s):b7 F£ P�-Mb Zi FE V EI� Ff-P 4 Max. MODEL#(S): S ®rales F 1 Lh �� <br /> ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS <br /> ELLD MANUFACTURER: Moo. MODEL#: Mal. <br /> PROGRAMMED LINE INTEGRITY TESTS: ❑ a.MINIMUM MONTHLY 0.2 g.p.h. ❑ b.MINIMUM ANNUAL 0.1 g p.h. Mae. <br /> WILL ELLD DETECTION OF A PIPING LEAK TRIGGER AUTOMATIC PUMP SHUTDOWN? ❑ a.YES ❑ b.NO Mai. <br /> WILL ELLD FAILURE/DISCONNECTION TRIGGER AUTOMATIC PUMP SHUTDOWN? ❑ a.YES ❑ b.NO M44. <br /> ❑ 4.INTEGRITY TESTING <br /> TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(Specify) M45. M46. <br /> ❑ 5.VISUAL MONITORING DONE: ❑ a.DAILY ❑ b.WEEKLY* ❑ c.MIN.MONTHLY&EACH TIME SYSTEM OPERATED*" M47. <br /> "Requires agency approval **Allowed fmmonitming of unburied emcrgmcy generator fuel piping only pa HSC§25281.5(b)(3) <br /> ❑ 6.PIPING IS SUCTION PIPING MEETING ALL REQUIREMENTS FOR EXEMPTION FROM MONITORING PER 23 CCR§2636(a)(3) <br /> ❑ 7.NO PRODUCT OR REMOTE FILL PIPING IS CONNECTED TO THE UST(s) <br /> Max. <br /> ❑ <br /> 99.OTHER(Specify) <br /> SJCEHD-d(07/03)-1/4 07/23/03 <br />