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� K UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN-(Page 1 of 2 TYPE OF ACTION ❑1.NEW PLAN2.CHANGE OF INFORMATION 090-1 PLAN TYPE [ 1.MONITORING IS ID NTICAL 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) - 3 BUSINESS NAME(Same as FACILITY NAME) 3 BUSINESS SITE ADDRESS 6 2CD CITY IN II.EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE Testing,preventive maintenance,and calibration of monitoring equipment(e.g.,sensors,probes,line leak detectors,etc.)most 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 I.ANNUALLY [3 °90-3.99.OTHER(Specify): 49631, III.MONITORING LOCATIONS 1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. 2.SITE PLOT PLAN/VIAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 634 964 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 VAULTS)WITH AUDIBLE AND VISUAL p ALARMS. (23(23 CCR§2632,2634) SECONDARY CONTAINMENT IS: ja a.DRY [Ib.LIQUID FILLED-❑ c.PRESSURIZED El d.UNDER VACUUM 6904 PANEL MANUFACTURER: / - --490-7. MODEL#: J 490.9 LEAK SENSOR MANUFACTURER: 490'9 MODEL#(S): 4so1u EI 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).(23 CCR§2643) 49611 PANEL MANUFACTURER: l 490'¢. MODEL COEE;z� .So 49613 IN-TANK PROBE MANUFACTURER: 49614. 490.15 LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILYNIGHTLY ❑ c.WEEKLY 49016 ❑ d.MONTHLY ❑ e.OTHERS 1 490'17 PROGRAMMED TESTS: ❑ a.0.1&Irh. ❑ b.0.2 g.p.h. ❑ c.OTHER(Specify): 4Wiy ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 49640 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§2645). TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS 49x21 490-22 5.TANK INTEGRITY TOTING(23 CCR§2643.1): 490-9 TEST FREQUENCYa.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): °9024 490-25 .OTHER (Specify). 49026 433x27 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 490.29 VISUAL ALARMS. (23 CCR§2636) SECONDARY CONTAINMENT IS:Ma.DRY ❑b.LIQUID FILLED [1c.PRESSURIZED ❑d.UNDER VACW_ M 49029 PANEL MANUFACTURER: £r�DBA- - 2��--- 490-30 I_MODEL#--�$ - 3 49x31 Z_.-_-tea-_ LEAK SENSOR MANUFACTURER: y/43c�FsA_12oaf _4903 MODEL#(S)_7`�1"3C-c_�'LO �_ 490'33 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. 19 a.YES ❑b.NO 490-34 FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. [Wa.YES ❑b.NO 4W35 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 3 CCR 2636_) 49636 MLLD MANUFACTURER(S): y�A s! - 49617 MODEL#(S): 490 ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS (23 CCR§2 6) 49039 ELLD MANUFACTURERS) °90'OO�MODEL#(S): 49°-41 PROGRAMMED IN LINE LEAK TEST: ❑ 1.MINIMUM MONTHLY 0.2 g.p.h. ❑ 2.MINIMUM ANNUAL 0.18P h. 49o-4z 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 1 ❑ 4.PIPE INTEGRITY TESTING 49645 TEST FREQUENCY ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS El c.OTHERS i 490-4649647 5.VISUAL PIPE MONITORING. 49049 FREQUENCYa.DAILY El b.WEEKLY ❑C.MM.MONTHLY&EACH TIME SYSTEM OPERATED' 490.49 •Alloue4 for waumnn afwburied corer ner raw[ppim only,r MC§25291.5 l ❑ 6.SUCTION-PIPING MEETS EXEMPTION CRITERIA 123 CCR§2636(a)(3)1. 49650 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.715 CONNECTED TO THE TANK SYSTEM 49651 ❑ 99.OTHER(Specify) 49652 49653 UPCF UST-D(1212007)1/4