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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STGE TANK• MONITORING PLAN-(Pae 1 of 2) NCIENE® TYPE OF ACTION [11.NEW PLAN ❑ 2.CHANGE OF INFORMATION 2009 0141 PLAN TYPE 0 1.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. FEB 1 490.2 (Check one item only) ❑ 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S) I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) l BUSINESS NAME(Same as FACILITY NAME) M,L S Lt r C 3. BUSINESS SITE ADDRESS 40b &rO-"I,s 1QAA,g cl J IOJ_ CITY /l� IN, 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): 4�3 4903bb III.MONITORING LOCATIONS ❑1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 2634)4904 IV.TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): Nf 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT 4905 VAULT(S)WITH AUDIBLE AND VISUAL ALARMS. (23 CCR§2632,2634) _ SECONDARY CONTAINMENT IS: ❑ a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED ❑d.UNDER VACUUM ac's _.____-_PANEL MANUFACTURE] 490-7 CO �N�--___-______a9oa MODEL_#: 490-8 -_ _____--__-_____ LEAK SENSOR MANUFACTURER: °90'� MODEL#(S): -17-2-AU I OMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK($).(23 CCR§2643) 490-11 PANEL MANUFACTURER: 49042. 490-13 -------PA _- MODEL#: ___IN-TANK PROBE MANUFACTURER_ _ _ __ __ 490-14. 49015 MODEL#(S): _ LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY 490-16 _ ____ ❑ d.MONTHLY _ __ El e.OTHER(Specify): 49017 PROGRAMMED TESTS_ [I a.0.1 g.p_ [Ih. b 0.2 g_.h. ❑ c.OTHER(Specify): 49016 p 490-19 ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): J02° ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§2645). TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS 49021 49022 ❑ 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 49033 TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): 49034 490-25 ❑99.OTHER (Specify): - 490-26 490-27 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 49-328 VISUAL ALARMS. (23 CCR§2636) SECONDARY CONTAINMENT IS:❑a.DRY ❑b.LIQUID FILLED ❑c.PRESSURIZED ❑d.UNDER VACUUM 490.29 PANEL MANUFACTURER: 49030 MODEL#: 49031 LEAK SENSOR MANUFACTURER: °90-32 ) MODEL#(S): 4W-33 ___-____-_-___ PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. ❑a.YES ❑b.NO 40-34 FAILUREIDISCONNECTION 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 PRODUCT FLOW WHEN A LEAK IS DETECTED(23 CCR 490.36 7- -__ -------- ----------l- �---------------- MLLD MANUFACTU _ RER(S): KED jPcCte. 490-37 MODEL#(S): 6 D 5�0 490-36 ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS (23 CCR§2636) 49039 ELLD MANUFACTURER(S) 49040 1 MODEL#(S):___ 490-01 PROGRAMMED IN LINE LEAK TEST: ❑ 1.MINIMUM MONTHLY 0.2 g.p.h. ❑ 2.MINIMUM ANNUAL 0.1 g.p.K 49042 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 49044 4.PIPE INTEGRITY TESTING 491ws TEST FREQUENCY Cl.'a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(Specify) 4904649047 ❑ 5.VISUAL PIPE MONITORING. 490.,15 FREQUENCY ❑ a.DAILY ❑ b.WEEKLY ❑C.MIN.MONTHLY&EACH TIME SYSTEM OPERATED' 4h149 •Allowed for rronftorinR Ofwbwed emam enermar fuel PrPang only rHSC§25M1,5b J ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR§2636(s)(3)1. 490.50 ❑ 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.71S CONNECTED TO THE TANK SYSTEM 490-51 ❑ 99.OTHER(Specify) 49052 490-53 UPCF UST-D(2/2007)1/4