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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 ® 1.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) 1. BUSINESS NAME(Same as Facility Name or DBA) 3. 7-Eleven# 32262 BUSINESS SITE ADDRESS 2360 Grantline 103. CITY Tracy 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.Such work must be performed by qualified personnel.[23 CCR§2632,2634,2638,26411 MONITORING E UIPMENT IS SERVICED ® 1.ANNUALLY 99.OTHERS iq' 490-34 Q ❑ ( �V)� 490.36. III. MONITORING LOCATIONS ❑ 1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN ® 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED [23 CCR§2632,26341 490-4. IV. TANK MON TTORING IS PERFORMED USING THE FOLLOWING METAOD(S) (Check all ® 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) 490.5. WITH AUDIBLE AND VISUAL ALARMS.[23 CCR§2632,26341 SECONDARY CONTAINMENT IS: ❑ a.DRY ® b.LIQUID FILLED ❑ c.PRESSURIZED ❑ d.UNDER VACUUM 490-6. PANEL MANUFACTURER: Veeder-Root 490-7 MODEL#: TLS-350 490-8. LEAK SENSOR MANUFACTURER: Veeder-Root 490-9. MODEL#(S): 302 490-10. ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).[23 CCR§26431 490-11. PANEL MANUFACTURER: 490-12. MODEL#: 490-13. IN-TANK PROBE MANUFACTURER: 490-14. MODEL#(S): 490-15. 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. OTHERc (S1>eY)� 49 if 4v°-18. _ ❑ c. _ 0-19. ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION[23 CCR§2646.11 490-20. ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)[23 CCR§26451 TESTING PERIOD: E] a.36 HOURS ❑ b.60 HOURS 49021. ❑ 5.TANK INTEGRITY TESTING PER[23 CCR§2643.11 490-23. TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify) 4 -25 90 . ® 99.OTHER(Specify): Overfill protection-Flapper 490-26. 490-27. V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METIOD(S) t(Cht k all ® 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE&VISUAL ALARMS. 490-28. [§26361 SECONDARY CONTAINMENT IS: ® a.DRY E] b.LIQUID FILLED ❑ c.PRESSURIZED Eld.UNDER VACUUM 490-29. PANEL MANUFACTURER:Veeder-Root 490-30. MODEL#: TLS-350 K 490-31 LEAK SENSOR MANUFACTURER: Veeder-Root 490-32 MODEL#(S): 352 STP 1208 fill sumps 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. ® 2.MECHANICAL LINE LEAK DETECTOR(MLLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS AND RESTRICTS OR SHUTS OFF 490-36. PRODUCT FLOW WHEN A LEAK IS DETECTED.[23 CCR§26361 MLLD MANUFACTURER(S):Vaporless(91&87)1 FE Petro(89) 490-37. MODEL#(S91D LD 2000/MLD(89) ago 38. ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS.[23 CCR§26361 490-39. ELLD MANUFACTURER(S): 490-40. MODEL#(S): 49041. PROGRAMMED IN LINE LEAK TEST: ❑ a.MINIMUM MONTHLY 0.2 g.p.h. ❑ b.MINIMUM ANNUAL 0.1 g.p.h. 490.41 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. -----.�-- - ----------490=0-5.. TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS ® c.OTHER(Specify) SB 989 every 36 mo. 490 46 _ _ 490.0-7. ❑ 5.VISUAL PIPE MONITORING. 490-48. FREQUENCY: ❑ a.DAILY ❑ b.WEEKLY ❑ c.MIN.MONTHLY&EACH TIME SYSTEM OPERATED* 49049. •Allowed for rwnitoxing of unburiedemergenry generator fuel piping only per HSC 2§5281.5(6X3) ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA.[23 CCR§2636(a)(3p 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) 49 4?0- 490-32. UPCF UST-D(12/2017)-1/4 www.unidoes.org