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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 ❑ 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)- OTT,/WATER SEPARATOR TANK I. FACILITY INFORMATION FACILITY ID # (Agency Use Only) _ t BUSINESS NAME (Same as FACILITY NAME) Flying J Travel Plaza - #618 3. BUSINESS SITE ADDRESS 1501 N. Jack Tone Rd 103' CITY Ripon 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, and that such work must be performed by qualified personnel. 23 CCR 2632, 2634, 2638, 2641 MONITORING EQUIPMENT IS SERVICED ® 1. ANNUALLY ❑ 99. OTHER (Specify): a9a-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: ❑ a. DRY ® b. LIQUID FILLED ❑ c. PRESSURIZED ❑ d. UNDER VACUUM 490-6 PANEL MANUFACTURER: Veeder Root 4942 t MODEL #: TLS -350 490-8 LEAK SENSOR MANUFACTURER: Veeder Root 490-9 MODEL #(S): 794380-303 -___________490=io ❑ 2. AUTOMATIC TANK GAUGING (ATG) SYSTEM USED TO MONITOR SINGLE WALL TANK(S). (23 CCR §2643) 490-11 PANEL MANUFACTURER: 490-12• MODEL #: 490-13 IN -TANK PROBE MANUFACTURER: 491-14. MODEL #(S): 490-15 LEAK TEST FREQUENCY: ❑ a. CONTINUOUS ❑ b. DAILY/NIGHTLY ❑ c. WEEKLY 490-16 ❑ d. MONTHLY El e. OTHER (Specify): 490-17 • ...490-18 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: Ela. 36 HOURS F-1 b. 60 HOURS 90-21 490-22 5. TANK INTEGRITY TESTING (23 CCR §2643.1): 490-23 TEST FREQUENCY: (p �')� : ❑ a. ANNUALLY [:1b. BIENNIALLY F-1 c. OTHER (Specify): 490-z 494255 ❑ 99. OTHER (Specify): VISUAL DONE DAILY 490-26 490-27 V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply) ® 1. CONTINUOUS MONITORING OF PIPE/ PIPING SUMP(S) AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 490-28 VISUAL ALARMS. (23 CCR §2636) SECONDARY CONTAINMENT IS: ®a. DRY ❑b. LIQUID FILLED ❑c. PRESSURIZED ❑d. UNDER VACUUM 490-29 PANEL MANUFACTURER: Veeder Root 490-30 MODEL #: TLS -350 - 490-31 ------------------------------•--------- - - - - - - - - -------------------------------- 49432 - -- - LEAK SENSOR MANUFACTURER: Veeder Root - - - - -- -- - - - - --- - MODEL #(S): 79_4380-208 490-33_ _ _ - -�_ 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 El 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 490.36 MLLD MANUFACTURER(S): 49°-37 MODEL #(S): --- -- -�-- 490-38 ❑ 3. ELECTRONIC LINE LEAK DETECTOR (ELLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS (23 CCR §2636) 490-39 _ ELLD MANUFACTURER(S) 490-40• ' MODEL #(S): _-__--____490.41__ -49042 PROGRAMMED IN LINE LEAK TEST: ❑ 1. MINIMUM MONTHLY 0.2 g.p.h. ❑ 2. MINIMUM ANNUAL 0.1 g.p.h.� 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. OTHERS i 49046490.47 ❑ 5. VISUAL PIPE MONITORING. 490-48 FREQUENCY ❑ a. DAILY ❑ b. WEEKLY ❑ C. MIN. MONTHLY & EACH TIME SYSTEM OPERATED" 49049 ` Allowed for mnitoring of unburied emEjency generator fuel piping only per HSC §25281.5(b)(3 ❑ 6. SUCTION PIPING MEETS EXEMPTION CRITERIA [23 CCR §2636(a)(3)]. 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) 49452 490-53 UPCF UST -D (12/2007) 10/23