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UNDERGROU.,J STORAGE TANK MONS ORING PLAN For use by Unidocs Member Agencies or where approved by your Local Jurisdiction Authority Cited. Title 23 CCR,Sections 2632(d)(1), 2634(d)(2), and 2641(h) TYPE OF ACTION ® 1.NEW PLAN ❑ 2.CHANGE OF INFORMATION Mor PLAN TYPE ® MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. Moe. (Check one item only) ❑ THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) - - FACILITY NAME Costco Wholesale Corporation gas station#658 Moa.• FACILITY SITE ADDRESS 3250 West Grantline Road M0°' CITY Tracy, 95377 Mos. H. EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE State law requires that testing,preventive maintenance,and calibration of monitoring equipment(e.g.,sensors,probes,line leak detectors,etc.)be performed in ^lob accordance with the equipment manufacturers'instructions,or annually,whichever is more frequent Such work must be performed by qualified personnel. Moz MONITORING EQUIPMENT IS SERVICED ® 1.ANNUALLY El99.OTHER(Specify): III. MONITORING LOCATIONS This monitoring plan must include a Site Plan showing the general tank and piping layouts and the locations where monitoring is perfortned(i.e.,location of each sensor, line leak detector,monitoring system control panel,etc.). If you already have a diagram(e.g.,current UST Monitoring Site Plan from a Monitoring System Certification form,Hazardous Materials Business Plan Lm2,etc.)which shows all required information,include it with this plan. IV. TANK MONITORING MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S):(Check all that apply) Mio ® 1.CONTINUOUS ELECTRONIC MONITORING OF TANK ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) SECONDARY CONTAINMENT IS: ❑ a.DRY ® b.LIQUID FILLED ❑ c.UNDER PRESSURE ❑ d.UNDER VACUUM M11 PANEL MANUFACTURER: Veeder Root M12. MODELM 35OR Mu LEAK SENSOR MANUFACTURER: Veeder Root MI4, MODEL#(s): 794380-301 M15. ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S) PANEL MANUFACTURER MI6_ MODEL Mn. IN-TANK PROBE MANUFACTURER MIs. MODEL#(S): M19. LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY M2e. ❑ d.MONTHLY ❑ e.OTHER(Specify): M21. PROGRAMMED TESTS: ❑ a.0.1g-P h. Elb.0.2 g.p.b. [3c.OTHER(Specify): M22. W3. ❑ 3.INVENTORY RECONCILIATION ❑ a.MANUAL PER 23 CCR§2646 ❑ b.STATISTICAL PER 23 CCR§2646.1 °- ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)PER 23 CCR§2645 TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS M23_ ❑ 5.INTEGRITY TESTING PER 23 CCR§2643.1 TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): M2]. ® 6-VISUAL MONITORING DONE: ® a.DAILY ❑ b.WEEKLY(Rrgn�.esrncr appn,rep Mze. ❑ 99.OTHER(Specify): V. PIPE MONITORING MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) Mao_ ® L CONTINUOUS ELECTRONIC MONITORING OF PIPING SUMP(SYTRENCH(ES)AND OTHER SECONDARY CONTAINMENT SECONDARY CONTAINMENT IS: ISI a.DRY ❑ b.LIQUID FILLED ❑ c.UNDER PRESSURE ❑ d.UNDER VACUUM M31. PANEL MANUFACTURER:Veeder Root _ W2. MODEL#: 35OR Mai. LEAK SENSOR MANUFACTURER: Veeder Root __ MODEL#(S): 794380-352 W5' WILL A PIPING LEAK ALARM TRIGGER AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN? EJ a.YES ❑ It.NO ^D6' WILL FAILUREIDISCONNECTION OF THE MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? E9 a.YES ❑ It.NO "D2. ® 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 MLLD MANUFACTURER(s):Red Jacket_Vyporless W8. MODEL#(5): FX2V. LD2000 ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS ELLD MANUFACTURER: Md0. MODEL#: Mar PROGRAMMED LINE INTEGRITY TESTS: ❑ a.MINIMUM MONTHLY 0.2 g.p.h. ❑ b.MINIMUM ANNUAL 0.1 g.p.h. M42. WILL ELLD DETECTION OF A PIPING LEAK TRIGGER AUTOMATIC PUMP SHUTDOWN? ❑ a.YES ❑ b.NO M43. WILL ELLD FAILURE/DISCONNECTION TRIGGER AUTOMATIC PUMP SHUTDOWN? ❑ a.YES ❑ b.NO Maa. ❑ 4.INTEGRITY TESTING TEST FREQUENCY: Ela.ANNUALLY ❑ b.EVERY 3 YEARS El c.OTHER(Specify) Mas Mab. ® 5.VISUAL MONITORING DONE: ® a.DAILY ❑ b.WEEKLY' ❑ c.MIN.MONTHLY&EACH TIME SYSTEM OPERATED" WT a Rc*.agency appovel as Allowd for monitoring of unburied emergan<y gannamr foci piping only W HsC 425281.5(6x3) ❑ 6.PIPING IS SUCTION PIPING MEETING ALL REQUIREMENTS FOR EXEMPTION FROM MONITORING PER 23 CCR§2636(ax3) ® 7.NO PRODUCT OR REMOTE FILL PIPING IS CONNECTED TO THE UST(s) MaB. ❑ 99.OTHER(Specify) UN-022A-115 www.anldomorg Rev.10/14/03