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02/27/2008 WED 11: 44 PAX 2094683433 SJC EHD 0022/025 UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN- Page 1 of 2) TYPE,OF ACTION ❑1.NEW PLAN N6 CHANGE OF INFORMATION 49(.1 PLAN TYPE 1.MONITORING IS IDENTICAL FOR ALL UST,AT THIS FACILITY. 3 (Check one item only) ❑ 2.TI41S PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S) 1. FACILITY INFORMATION FACILITY 1D#(Agency Use Only) - - 1 BUSINESS NAME(Same as FACILITY NAME) A P, BUSINESS SITE ADDRESS Jtj 10 S b e Po[h 60 P)(.)4!1tO3 CITY Ti" (-,6.t ' 101 IL EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE Testing,preventive maintenance,and calibration of monitoring equipment(e.g.,sensors,probes,tine 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{+2632,2634,2635.2641) _ MONITORING UIPMENT IS SERVICED ANNUALLY 99.OTHER(S 1f 4 -3n EQ 1.�, ❑ Y) 49900.36 �- III.MONITORING LOCATIONS ❑1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. Mr2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 2634)497-4 ) IV.TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): L CON'T'INUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT 490.5 7 VAULT(S)WITH AUDIBLE AND VISUAL�RMS. (23 CCR§2632.2634) ' SECONDARY CONTAINMENT IS: U a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED ❑d.TINDER VACUUM 4x1.6 ' PANEL MANUFACTURER: I� 11`O O� 641' ° MODL-L#: L S 3_``r U 4 " t-- ------ -------- - ------ --- --- ----- --T ..2.--- LEAK SENSOR MANUFACTURER: b 5911' MODEL#(S): 0 490-10 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S)_:(23 CCR§2643) 490-11 PANEL MANUFACTURER: 490-1z. MODEL#: 470-13 __..._..-- ----- --- -----..--- ---------- - -- 4x1-14, 4990-15 TN-TANK PROBE MANUFACTURER: MODEL-C LEAK TEST FREQUENCY: ❑ a CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY 490-16 e ❑ d.MONTHLY ❑ e.OTHER(Specify): 490.17 96.r ---- -- - -- ---- ---------- ------ -------- PROGRAMMED TESTS: [Ia.0.1 g.p.h. ❑ b.0.2 g.p.h. ❑ c.OTHER(Specify): --- axi 19 ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 490-20 1 ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§2645). TESTING PERIOD: ❑ a.36 Hnx� OURS ❑ b.60 HOURS d90'21 zz 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 4x7-23 TEST FREQUENCY: C] a.ANNUALLY C1b.BIENNIALLY [Ic.OTHER(Specify): 470-35 ' 4x1-zs C]99.OTHER (Specify): 49900-27 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 490-2" VISUAL ALARMS. (23 CCR§2636) SECONDARY CONTAINMENT IS:U0-.DRY ❑b.LIQUID FILLED ❑c.PRESSURIZED_❑d.UNDER VACUUM 490-29 I PANEL MANUFACTURER: V61-11-it "01- 400.30 1 MODEL ^��T� �- 470.31 ' 490.33 LEAK_SENSOR MA_N490-2 MANUFACTURER: 1L--_-_-__ i MODEL#(S)_,-,�__3 x,.�_ - PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. I�a YES ❑b NO 490'34 FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. 11""a.YES ❑b.NO 490-35 2.MECHANICAL.LINE LEAK DETECTOR(MLLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS AND REST'RICT'S OR SHUTS OFF -PRODUCT FLOW WHEN A LEAK IS DETECTIFD.Q CCR 2636) - ----_____ - 490.36 MLLD MANUFACI'URER(S): 491-37 MODEL#(S): 470-38 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS (23 CCR§2636) -490-9 1 j?f _.-____.___.-_.._._.�_-.__-_--�___.___-- ------ ---_.___---__.------•- -........ 4xlro. t-------------• -- 490-41 ELLD MANUFACfURER(S) E D t�t)V 'r MODEL#(S): L ]� - PROGRAMMED IN LINE LEAK TEST ❑ 1.MINIMUM MONTHLY 02 g.p.h. ❑ 2.MINIMUM ANNUAL 0.1 g.p.h. 490 2 ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. &a.YES ❑b.NO 490-13 ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. g a.YES ❑b.NO d704, 4.PIPE INTEGRITY TESTING 490.45 1 TEST FREQUENCY Cj a.ANNUALLY 0 b.EVERY 3 YEARS c.OTHERS(Specify) 49446491.47 5.VISUAL PIPE MONITORING. 490.419 FREQUENCY ❑ a.DAILY ❑ b.WEEKLY ❑C.MIN.MONTHLY&EACH TIME SYSTEM OPERATED* 41n49 `A11011od for mowin;of unburied-emmcy eneni-fuel pipins w1v per NSC 25261.5 6 3) ❑ 6.SUCTION PIPING MF,ETS EXEMPTION CRITERIA 123 CCR§2636(a)(3)1. 4xi-50 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.715 CONNECTED TO THE TANK SYSTEM 4!x1-51 i 4x752 ❑ 99.OTHER(Specify) UPCF UST-D(12/2007)114