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0L @ED UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MAY 3 W10 MONITORING PLAN-(Page 1 of 2) TYPE OF ACTION ❑1.NEW PLAN ID 2.CHANGE OF INFORMATION CESL ago t PLAN TYPE ® 1.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. PER ° 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 BUSINESS NAME(Same as FACILITY NAME)FLYING J TRAVEL PLAZA 3. BUSINESS SITE ADDRESS 15237 THORNTON ROAD 103. CITY LODI 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 ID 1.ANNUALLY ❑ 99.OTHER(Specify): 490.3b III.MONITORING LOCATIONS 1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. 0 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 2634)4904 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: ID a.DRY ID b.LIQUID FILLED ❑ c.PRESSURIZED ❑d.UNDER VACUUM 490-6 ------------------------------------------------------------------------------------ 490-7. 1-2 PANEL MANUFACTURER: VEEDER-ROOT • MODEL#: TLS-350 490-8 LEAK SENSOR MANUFACTURER: VEEDER-ROOT 491-9. 1 MODEL#(S): 303 490-10 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 MANUFAC__T_UR_ER_: 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 h. b.0.2 h. c.OTHER490-19 g•P• ❑ g•P• ❑ (Specify): a9o-t9 ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 490-20 2645). TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS 490-21 ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR § a9azz 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 490-23 TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): 490-25 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:Oa.DRY ❑b.LIQUID FILLED ❑c.PRESSURIZED ❑d.UNDER VACUUM 490-29 PANEL MANUFACTURER:VEEDER-ROOT 490-30 MODEL#: TLS-350_______a 49031 LEAK SENSOR MANUFACTURER: 490 32 MODEL#(S): 322 490.33 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. ID a.YES ❑b.NO --- 490-34 FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ID 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 PRODUCT FLOW WHEN A LEAK IS DETECTED 23 CCR 2636 490-36 MLLD MANUFACTURER(S):FE PETRO 490-37 MODEL#(S): MLD 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) 49041. MODEL#(S):� 49041 PROGRAMMED IN LINE LEAK TEST: ❑ 1.MINIMUM MONTHLY 0.2 g.p h. ❑ 2.MINIMUM ANNUAL 0.1 g.p.h. 490-42 ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 490.43 ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 490-44 4.PIPE INTEGRITY TESTING 490-45 TEST FREQUENCY 0 a.ANNUALLY 0 b.EVERY 3 YEARS 0 c.OTHERS i 49046 490-47 5.VISUAL PIPE MONITORING. 490-48 FREQUENCY ❑ a.DAILY ❑ b.WEEKLY ❑c.MIN.MONTHLY&EACH TIME SYSTEM OPERATED" 49049 `Allowed for monitoring of unburied emergency enerator fuel pipi2g only Per HSC 25281.5 b 3 ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA 123 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 490-51 490-52 ❑ 99.OTHER(Specify) 490-53 UPCF UST-D(12/2007)114