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m UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN-(Page I of 2) TYPE OF ACTION ❑ 1.NEW PLAN 2.CHANGE OF INFORMATION 490.1 PLAN TYPE 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) BUSINESS NAME(Same as FACILITY NAME) - tAAGLL (a S h, U ts� ,beiorcssv r 1 3 BUSINESS SITE ADDRESS -7-1-1 Q , .FIC0j 4C11 C1 CIT S 4 104 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)- EQUIPMENT IS SERVICED rer 1.ANNUALLY 99.OTHERS ci 490.3a MONITORING E Q 1Q ❑ ( Pe �')� 590-3b III.MONITORING LOCATIONS ❑ 1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 2634)49o-4 IV.TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): Q 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT 490-5 VAULT(S)WITH AUDIBLE AND VISUAL ALARMS. (23 CCR§2632,2634) SECONDARY CONTAINMENT IS: DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED ❑d.UNDER VACUUM 490-6 --- - --- -- ------------ ---- - --------- ----------------------------- ------- PANEL MANUFACTURER: p�( MODEL#: LS 3�(7 490.8 LEAK SENSOR MANUFACTURER: e.-r 4919' 1 MODEL#(S): p 49410 ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).(23 CCR§2643) 490-11 PANEL MANUFACTURER: 490.12' MODEL#: 490-13 ------------------------------------------------------------------------------------------------------------------------ IN-TANK PROBE MANUFACTURER: ___ __ _ 490-14. MODEL#(S): 490-15 LEAK TEST FREQUENCY_ Ela.CONTINUOUS C3b.DAILY/NIGHTLY - ❑ c.WEEKLY - 490.16 ❑ d.MONTHLY ❑ e.OTHER(Specify): 490.17 PROGRAMMED TESTS: ❑ a.0.1 h. ❑ b.0.2 h. ❑ c.OTHERS ci 490-19 g.p.h. g•P• (Specify): 490-19 ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 490-20 ❑ 2645). TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS 490-21 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR § av0-zz ❑ 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 490-23 TEST FREQUENCY: §4 a.ANNUALLY Elb.BIENNIALLY ❑ c.OTHER490'24 (S pecify): ago-zs ❑99.OTHER (Specify): 490.27 a9o•rr V.PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) 43 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 490-28 VISUAL ALARMS. (23 CCR§2636) SECONDARY CONTAINMENT IS:Ma.DRY ❑b.LIQUID FILLED ❑c.PRESSURIZED ❑d.UNDER VACUUM 490.29 ---------------------------------------- ------------ ---- - --------------------------------•------ 490-30 PANEL MANUFACTURER: ----_ #:MODEL ------------ t•--------- - 490-31 ------------•------- r9o-ii -•---• LEAK SENSOR MANUFACTURBR: _ 1_MOD_EL#(S): 490-33 --__ _ _ PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN_- - - :0 a.YES ❑b.NO 490.34 FAILURE/DISCONNECTION 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 CCR2636Z490-36 MLLD MANUFACTURER(S): yb&I 490-37 MODEL#(S):120 ffebwa 490-38 ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS (23 CCR§2636) 490-39 ELLD MANUFACTURER(S) 490-40. 1 MODEL#(S): ago al - --------------- --------- ----•---- ---------------------------- PROGRAMMED ------------------------PROGRAMMED IN LINE LEAK 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 ELLD FAILUREMISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 490-" ❑ 4.PIPE INTEGRITY T TING 490-45 TEST FREQUENCY a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(Specify) 490-46490-47 5.VISUAL PIPE MONITORING. 49048 FREQUENCY ❑ a.DAILY ❑ b.WEEKLY ❑C.MIN.MONTHLY&EACH TIME SYSTEM OPERATED* 490-19 'Allowed for moni toring of unburied emer me memlor fuel piping onk per HSC 25281.5 6 3 ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR§2636(a)(3)1. 490.50 ❑ 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM 490-51 ❑ 99.OTHER(Specify) 490-52 490-53 UPCF UST-D(12/2007)1/4