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• LVL' jr1V 1JJ UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUNDSTORAGETANK MONITORING PLAN - Pae 1 of 2 T1fPE OF ACTION 12f I. NEW PLAN [:12. CHANGE OF INFORMATION PLAN TYPE 21 L MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. 4904 (Cheek one item only) ❑ 2. THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): I. FACILITY INFORMATION FACILITY TO # (Agency Use Only) n. BUSINESS NAME (Same as Facility Name or DBA) 3. C05TCO Gasoline Loc. No. 38 BUSINESS SITE ADDRESS toe. 1616 Hammer Lane CITY Stockton Boa. II. EQUIPMENT T19STING AND PREVENTIVE MAINTENANCE. Testing, preventive maintenance, and calibration of monitoring equipment (e.g.. sensors, probes, line leak detectors, etc.) muse be performed at the frequency specified bkr the equipmmt manufacturers' instructions, or mnualty, whi£hever is more fieguent Such work must be performed by g_ualified personnel. ( CCx 42612, 2634, 2633, zbn) MONITORING EQUIPMENT IS SERVICED At least [RrLANNUALLY 99. OTHER (Specify): per Mfrs. IZlStrs.49eya. 490.3b. - M. MONITORING LOCATIONS 1. NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN ❑ 2. SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED ID CCR §2632.26341 49M14' W. TANK MONITORING IS PERFORMED USING_ THE FOLLOWING METHODS)that apply) 1. CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR (INTERSTITIAL) SPACE(S) OR SECONDARY CONTAINMENT VAULT(S) 4903. WITH AUDIBLE AND VISUAL ALARMS. ID CCR §263x, 2634],,! SECONDARY CONTAINMENT IS: ❑ & DRY e2 b. LIQUID FILLED ❑ c. PRESSURIZED ❑ d. UNDER VACUUM 4904, PANEL MANUFACTURER: Veeder Root 490'2' MODEL#: TLS-35OR 49x3. LEAK SENSOR MANUFACTURER: Veeder Root 490-9 MODEL #(S): 794380-301 49aia �( 2. AUTOMATIC TANK GAUGING (ATG) SYSTEM USED TO MONITOR SINGLE WALL TANKlS3. (23 MR §2643] 4s0-1 t. PANEL MANUFACTURER: 490'31 MODEL #. 490'13. IN -TANK PROBE MANUFACTURER: 490.14' MODEL #(S): 490-13. LEAK TEST FREQUENCY: ❑ a. CONTINUOUS ❑ b. DAH.Y/NIGHTLY ❑ c. WEEKLY 49046. ❑ d. MONTHLY ❑ e.OTHER (Specify): 490'17. PROGRAMMED TESTS: ❑ a. 0.1 h. - ❑ b. 0.2 h. c.OTHER(S t ): 4-Wis. ❑ 3. MONTHLY STATISTICAL INVENTORY RECONCILIATION (23_C_C_R§2646.11 49 20. ❑ 4. WEEKLY MANUAL TANK GAUGING (MTG) ID ccR §264s1 TESTING PERIOD: ❑ a. 36 HOURS ❑ b. 60 HOURS490-21. ❑ 5. TANK INTEGRITY TESTING PER ID CCR §2643.11 490-M. TEST FREQUENCY:___ [I&ANNUALLY [Ib. BIENNIALLY [3c. OTHER(Specify): _°n E4' �/- 99.OTHER (spcc]fy): Tank Probe VR -847390-109; Ball Float - 90g Capacity Fill Point ei 492124:6. V. PIPE MONITORING IS PERFORMED USING THE -FOLLOWING METHOD(S) 1. CONTINUOUS MONITORING OF PIPE/PIPING SUMPS) AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE At VISUAL ALARMS. 490-23, (21"§26361 SECONDARY CONTAINMENT IS: [Za. DRY ❑ b. LIQUID FILLED ❑ c. PRESSURIZED ❑ d. UNDER VACUUM °90x9. PANEL MANUFACTURER: Veeder Root 490'30. MODEL#: TLS -350R 490-31. LEAK SENSOR MANUFACTURER: Veeder Root 49032. MODEL#(S): 490'33' PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP (i.e., TURBINE) SHUTDOWN. 91 a. YES ❑ b. NO 490'34' FAH.URVDISCONNECIION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. �a. YES ❑ b. NO 490,15. _ ❑ 2. MECHANICAL LINE LEAK DETECTOR (MLLD) THAT ROUTINELY PERFORMS 3.6 g.p.h. LEAK TESTS AND RESTRICTS OR SHUTS OFF 490.36. PRODUCT FLOW WHEN A LEAK IS DETECTED. TD CCR12636] MLLD MANUFACTURER S: 490'37' MODEL#(S): 490'33• tff-3. ELECTRONIC LINE LEAK DETECTOR (ELLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS. ID CCR§26363 490x9. ELLDMANUFACTURER(S): Veeder Root 49040. MODEL#(S): 848480-001 490x1. PROGRAMMED IN LINE LEAK TEST: ❑ a. MINIMUM MONTHLY 0.2 g.p.h. ❑ b. MINIMUM ANNUAL 0.1 g.p.h. 49042. ELLD DETECTTON OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. Z.,/a. YES [-]b. NO 49aa3' ELLD FAILUREMISCONNECTION TRIGGERSl3Ugo. PUMP SHUTDOWN. o. YES ❑ b. NO 49044. ..__-_ ❑ 4. PIPE AITEGRITY TESTING. ---------- 49045. TBST FREQUENCY: [I a. ANNUALLY b. EVERY 3 YEARS.,.-, c OTHER S,cify). 190.°6. - - -------------�------------------ ❑ 5. VISUAL PIPE MONITORING. 41043. FREQUENCY: ❑ & DAILY ❑ b. WEEKLY ❑ C. MIN. MONTHLY & EACH TIME SYSTEM OPERATFD• 4-4. ---________,-_ _ _�_ •AVoxN fa m9eitai.3ofu.buie6 en..v9..r3.nmurlvel9l.ivanlr ar FL4C §33291.5(b�{ll _.,,-_. ❑ 6. SUCTION PIPING MEETS EXEMPTION CRITERIA. ID CCR 9263y.x3)) 4W50. ❑ 7. NO REGULATED PIPING PER HEALTH AND SAFETY CODE, DIVISION 20. CHAPTER 6.715 CONNECTED TO THE TANK SYSTEM. s9o-si. ❑ 99.OTHER (Speci ) 49a53. UPCF UST -D (12(2007) -1/4 _ w .apldocs.org