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IFIED PROGRAM CONSOLIDATED FORM UNDERGROUNDSTORAGETANK MONITORING PLAN- Pae I of 2) TYPE OF ACTION El 1.NEW PLAN El 2.CHANGE OF INFORMATION 490-1 PLAN TYPE 19 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) _ I BUSINESS NAME(Same as FACILITY NAME) 1 /G U O� C J BUSINESS SITE ADDRESS -F0 C Q I I yj�7 `� C,'- c11003. CITY II.EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE Testing,preventive maintenance,and calibration of monitoring equipment(e.g.,sensors,probes,line leak detectors,etc.)must he 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, MONITORING EQUIPMENT IS SERVICED I.ANNUALLY ❑ 99.OTHER(Specify): R 490-30- 490-3b III.MONITORING LOCATIONS L NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 634)490.4 IV. TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACES)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: /�� Tf��I r/� 490a.�- - ---�� 490-a ------ -�'!_L S?_�M C _______ _�_MO__D_E_L#:___n _ LEAK SENSOR MANUFACTURER: 49°"9 MODEL#(S):'/ ,nf� a90-10 ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).(23 CCR§2643) V 490-11 PANEL MANUFACTURER: 490-12 490-D __________-______ MODEL#: _ IN-TANK-PROBE MANUFACTURER: 490-14. MODEL#(S): 49o-IS LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ c.WEEKLY Q b.DAILY/NIGHTLY 490-16 __________----------- ❑ d.MONTHLY c.OTHER(Specify).__ 490-17 PROGRAMMED TESTS: Ela.0.1 g.p.h. ❑ b.0.2 g.p.h. ❑ c.OTHER(Specify): 490-I 490-199 ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 490-20 ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§2645). TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS 490-21 490-22 ❑ 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 490-v TEST FREQUENCY: [I a.ANNUALLY ❑ b.BIENNIALLY Elc.OTHER(Specify): 490-24 490-25 ❑99.OTHER (Specify): 490-26 V.PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) 490-23 ❑ I.CONTINUOUS MONITORING OF PIPE/PIPING SUMPS)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: 49x3° MODEL#: 4900-1 LEAK SENSOR MANUFACTURER: 490"]2_ MODEL# S 490-33 ____-____--_-- ----_-__ -_ _ ___(_ ______________________.1. PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. El a.YES El b.NO 49°-]4 FACKILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 490-35 2.MECHANICAL LINE LEAK DETECTOR(MELD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS AND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK IS DETECTED 23 CCR�636L_______ __ _ _ 490.36 MLLD MANUFACTURER(S): exEfi 490-39 MODEL#(S): - .0 5Gk 490-38 ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS (23 CCR§2636) 490-39 ELLD MANUFACTURERS) ___ 490-00 1 0-9041 --- ----------IN--E-L- _- I MODEL#(S): PROGRAMMED INLEAK TEST: ❑ 1.MINIMUM MONTHLY 0.2 g.p.h. ❑ 2.MINIMUM ANNUAL 0.1 g.p.h. 49042 ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 49043 ELLDFAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. 11a.YES ❑b.NO 490-44 4.PIPE INTEGRITY T S ING 49045 TEST FREQUENCY Wa.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(Specify) 4904649047 ❑ 5.VISUAL PIPE MONITORING. 49048 FREQUENCY ❑ a.DAILY ❑ b.Le WEEKLY ❑c.MIN.MONTHLY&EACH TIME SYSTEM OPERATED- 490,49 Allowed for mo itonn of unburied em enc everatar fuel piping0171 er HSC§25281.5(b)(3) ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR§2636(a)(3)1. 490-60 490-51 El 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM ❑ 99.OTHER(Specify) 490-52 490.53 UPCF UST-D(12/2007)1/4