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Ah Ah NIFIED 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 ['I. 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) I I_ - 1 BUSINESS NAME (Same as FACILITY NAME) iA'(r"��G((iGl ncn�i tj- � 3. BUSINESS SITE ADDRESSD (� Loo I �� r n o 103 CITY s tl�� 1e4 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, and that such work must be performed by qualified personnel. 23 CCR 2632, 2634, 26382 2641 -��-� -- MONITORING EQUIPMENT IS SERVICED [Dl. ANNUALLY ❑ 99. OTHER (Specify): 490.3a 4911_3b III. MONITORING LOCATIONS ❑ 1. NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. ❑ 2. SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR §2632, 2634)490-4 IV. TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): 1. CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR (INTERSTITIAL) SPACE(S) OR SECONDARY CONTAINMENT 490-5 VAULT(S) WITH AUDIBLE AND VISUAL ALARMS. (23 CCR §2632,2634) SECONDARY CONTAINMENT IS: aa. DRY ❑ b. LIQUID FILLED ❑ c. PRESSURIZED ❑ d. UNDER VACUUM 490 -6 ----------------------------------- ------------------------ ----------- ------------------------------------------- PANEL MANUFACTURER: �40 - Ik " t�Y 490-7 MODEL #: (�A- 0 Z/ -- 490-8 - ------------------------------------ -- ----------------- ------ LEAK SENSOR MANUFACTURER: (,CGtFL - fA � r �' 490-9. MODEL #(S): - ' 490.10 ❑ 2. AUTOMATIC TANK GAUGING (ATG) SYSTEM USED TO MONITOR SINGLE WALL TANK(S). (23 CCR §2643) 490:11 PANEL MANUFACTURER: 490-11 MODEL #: 490.13 -------- --------------------------------------------- -------------- --- --------- ---- ---- ------------------ ------------------ ----- 490-14- ------------------------ ---------------------- IN -TANK PROBE MANUFACTURER: MODEL #(S): ago -is - - -- -- - - - -- -- -- - -- - - - - ------------------------------------------------------------------------------------------------------------------------------------- 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): 490-19 ❑ 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 E]b. 60 HOURS 490-21 490-zz ❑ 5. TANK INTEGRITY TESTING (23 CCR §2643.1): 490-23 TEST FREQUENCY: F]a. ANNUALLY Elb. BIENNIALLY Elc. OTHER (Specify): 490-24 490-25 ❑ 99. OTHER (Specify): 49900-27 V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply) I. CONTINUOUS MONITORING OF PIPE/ PIPING SUMP(S) AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 490-28 VISUAL ALARMS. (23 CCR §2636) SECONDARY CONTAINMENT IS: E3 DRY ❑b. LIQUID FILLED [1c.PRESSURIZED ❑d. UNDER VACUUM 490-29 --------------------------------------------------------------------------------------------------------------------------------------------------- ---------------- -- -------- PANEL MANUFACTURER: ` MODEL #:_�- L� C'G( {'-----�---� l e /"1`------------- 490-31 - - - -0-90-30 - -------------------------------L - - -- - # LEAK SENSOR MANUFACTURER: /� _ W) 3T (S) 5 f L'Gf IZ f ,i_Le/ t 490 33 - - - - -1 -----------------------1-MODEL - PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP (i.e., TURBINE) SHUTDOWN. ❑ a. YES Erb, NO 490-34 FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a. YES [�i. NO 490-35 2. MECHANICAL LINE LEAK DETECTOR (MLLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS AND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK IS DETECTED( 23 CCR 2636 - - --------------------------------------------------------------------------------- ago -36 -------------------------------------------- -- - MLLD MANUFACTURER(S): ce � L 490 37 MODEL #(S): F -/,)490-3R ❑ 3. ELECTRONIC LINE LEAK DETECTOR (ELLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS (23 CCR §2636) 490-39 --------------------------------------------------------------------------------------------------------------------------------------------- ----- ------------------------ 490-00. ELLD MANUFACTURER(S)� MODEL #(S) ----------- -------------------------------------------------------------------------------------------------------------------------- 490-41 PROGRAMMED IN LINE LEAK TEST: ❑ 1. MINIMUM MONTHLY 0.2 g.p.h. E]2. MINIMUM ANNUAL 0.1 g.p.h. 4904z 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) 490-4649047 ❑ 5. VISUAL PIPE MONITORING. 49048 FREQUENCY ❑ a. DAILY ❑ b. WEEKLY ❑ C. MIN. MONTHLY & EACH TIME SYSTEM OPERATED* 49049 Allowed for monitoring of unburied emergmcy generator fuel piping only per HSC §25281.5 6 3 ❑ 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 ❑ 99, OTHER (Specify) 490-52 490-53 UPCF UST -D (12/2007) 1/4