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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUNDSTORAGETANK MONITORING PLAN-(Pae 1 of 2) war TYPE OF ACTION ❑1.NEW PLAN S 2.CHANGE OF INFORMATION PLAN TYPE ❑ 1.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. 990-1 (Check one item only) ❑ 2.THIS PLAN COVERS ONLY TILE FOLLOWING UST SYSTEM L FACILITY INFORMATION FACILITY ID#(Agency Use BUSINESS NAME(Same as FACILITY NAME) Rancho San Miguel '' BUSINESS SITE ADDRESS 610 S. Cherokee 1m. CITY Lodi ra. II.EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE Testing,preventive maintenance,mid calibration of monitoring equipment(e.g.,sensors,probes,line leak detectors,etc.)most be pedbrmed at the frequency specified by the equipment manufacturen'imlructions,or mutually,whichever is mora frequent,and that such work must be perfomled by qualified personnel. 23 CCR2672L2634z2638,264 _ MONITORING EQUIPMENT IS SERVICED ® I.ANNUALLY ❑ 99.OTHER(Specify): 4y 3y III.MONITORING LOCATIONS 1.NEW SITE PLOT PLANIMAP SUBMITTED WITH THIS PLAN. 2.SITE PLOT PLANAIAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 2634)4504 IV.TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): I.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACES)OR SECONDARY CONTAINMENT 45 VAULT(S)WITH AUDUiLE AND VISUAL.ALARMS. (23 CCR§2632,2634) SECONDARY CONTAINMENT IS: S It.DRY ❑ b.LIQUID FILLED ❑ 0.PRESSURIZED ❑d.UNDER VACUUM PANEL MANUFACTURER: Veedef-Root 1901 MODEL#: TLS-350 'rte -______-__ LEAK SENSOR MANUFACTURER: Veedef-Root 490"9' MODEL#(S): 7Q488Q469--7q 4110 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO\ION FOR SINGLE WALL TANK(S).(23 CCR§2643) 490'11 PANEL MANUFACTURER: 4112" MODEL#: 4113 IN-TANK PROBE MANUFACTURER: °911°' MODEL#(S).___ _ 4509 _______ LEAK TEST'FREQUENCY: [:I a.CONTINUOUS ❑ b.DAILYMIGHTLY __❑ a WEEKLY 490'106 [I d MONTHLY _C3 e.OTHER(Specify)_ _ _°�v PROGRAMMED TESTS: Ela.O.I gp.b. ❑ It.02 g.p.h. El a OTHER(Specify): ------- -.---.-_ - 4�a:v ❑ 3.JIONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): '19120 ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§2643). TESTING PERIOD: ❑ &36 HOURS ❑ b.60 HOURS 4r 21 S.TANK INTEGRITY ,STING(23 CCR§2643.!): 4113 TEST FREQUENCY.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): 41x° 4124 [199.OTHER (Specify): 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 CONTAINMENTWITH AUDIBLE AND 4028 VISUAL ALARMS. (23 CCR§2636) SECONDARY CONTAINMENT IS:Ea.DRY ❑b.LIQUID FILLED ❑c.PRESSURIZED ❑d.CINDER VACUUM 4a29 PANEL MANUFACTURER:Veedef-Root 40'10 MODEL#: TLS-350 490.31 LEAK_SENSOR_MANUFACTURER:_Veed_ef-_Root32 MO_DEL#_(S): 795380208_ 4 33 PIPM0 LEAK ALARM TRIGGERS AUTOMATIC PUMP(ix.,TURBINE)SHUTDOWN. S a YES ❑b.NO 4034 FAILURE(DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. S a.YES ❑b.NO +9039 2.MECHANICAL LIME LEAK DETECTOR(MLLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS AND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK IS DF.T_ECTEDS23 CCR X61...__�______________________________ +91x0 -_... MLLD MANUFACTURER(S):Red JackeUFE Petro °913' MODEL#(S): FX2V,STPMLD-E 4130 ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.ph�T.�LEAK TESTS (23 CCR§2636) 45139 ELLD MANUFACTURER(S) ____._____490�.1'v'ODEL#(S): °5041 PROGRAMMED IN LME LEAK TEST: ❑ 1.MINIMUM MONTHLY 0.2 g.p.h. El2.MINIMUM ANNUAL 0.1 g.p.h. 4 "43 ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a YES ❑b.NO 49043 ELLD FAILURE/D[SCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑&YES ❑b.NO ;9p9° 4.PIPE INTEGRITY TESTING 4o-rs TEST FRL' UENCY ❑ a ANNUALLY b.EVERY 3 YEARS ❑ c.OTHER cif 4o 45047 5.VISUAL PIPE MONITORING. wars FREQUENCY S a.DAILY ❑ b.WEEKLY ❑c.mN.MONTHLY&EACH TIME SYSTEM OPERATED- 449 aAlbxd lbrmeeiroritiq ofvnbwid em < emaiorfiM i in wJ naC 25xi1.5 l ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR§2636(a)(3)I• 40-50 Ll 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM wase ❑ 99.OT'FIER(Specify) 4M53 UPCF UST-D(12/2007)1/4