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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN- Page 1 of 2) TYPE OF ACTION El1.NEW PLAN 2.CHANGE OF INFORMATION 490.1 PLAN TYPE XL 1,MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. ° _ (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) I#tAfC C19V)47-Qy S Tk47DM a-6 BUSINESS SITE ADDRESS jil1 F. KE jLEMR14 LMC CITY L(� b'r 10° 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 _____ MONITORING EQUIPMENT IS SERVICED UK I ANNUALLY ❑ 99.OTHER(Specify): 4%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)49oa IV.TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT 49x5 VAULT(S)WITH AUDIBLE AND VISUAL ALARMS. (23 CCR§2632,2634) SECONDARY CONTAINMENT IS: K a.DRY E] b.LIQUID FILLED ❑ c.PRESSURIZED [Id.UNDER VACUUM - -_--_-- ° PANEL MANUFACTURER: [L MODEL#_ CSM G 490-8 _ _ LEAK SENSOR MANUFACTURER: °Y09 MODEL#(S): ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(Sk(23 CCR§2643) 490-11 PANEL MANUFACTURER. - 490-¢ MODEL#: :i ' ,_,._,_' - 49013 TANK PROBE MANUFACTURER: 4%-14, MODEL#(S):.__._._---_----------------------------.-----490.15 LEAK TEST FREQUENCY: ( 1 a.CONTINUOUS is b.DAILYMIGHTLY ❑ c.WEEKLY 4W-16 ❑ d.MON_THL_Y___--__-_-_-_---(] e.OTHER(Specify).-__---_-._- -_-_-_-490.11 PROGRAMMED TESTS: ❑ a.0.1 h. ❑ b.0.2 h. ❑ c.OTHER490.11 BP g.p.h. (Specify): 4YU-19 _ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 420 _ 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§2645). TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS 490.21 490-zz 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 490-23 TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY c.OTHER(Specify): 490-25 099.OTHER (Specify): 49026 4911-21 V.PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMPS)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 490-2e VISUAL ALARMS. (23 CCR§2636) SECONDARY CONTAINMENT IS:Ma.DRY []b.LIQUID FILLED ❑c.PRESSURIZED ❑d._UNDE_R VACUUM 49o-z9 PANEL MANUFACTURER: _ I(. L-D _9o-1D�MODEL# __CA _--.--_--_-_--.---- e90-11 _. _._._.7t ry- 412 MODEL#S L I�6 490-31 LEAK SENSOR MANUFACTURER: C-O _�_L ___-.___"__"_._- L�13f ------ --- ----- -- - PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. Ka.YES ❑b.NO 49na4 FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. a.YES ❑b.NO 0111-35 2.MECHANICAL LINE LEAK DETECTOR(MLLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TEST AND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK IS DETECTED 123 CCR 2636 . 411436 Y� -_§-_� _____---_____--_______.____..______.....__ MLLD MANUFACTURER(S): D °9Udl MODEL#(S): p Q vrvls ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS (23 CCR§2636) -4so-a9 ____ -_._.__ ELLD MANUFACTURERS) 490x0_I-MODEL#(S):.........................-.......490.41__ PROGRAMMED IN LINE LEAK TEST: ❑ 1.MINIMUM MONTHLY 0.2 g.p.h. ❑ 2.MINIMUM ANNUAL 0.1 g.p.h. 4911-02 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 4N114 ❑ 4.PIPE INTEGRITY TESTING 490x5 TEST FRE UENCY ❑ &ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER Specify) 4mw6490-41 Iq 5.VISUAL PIPE MONITORING. 4WI-41 FREQUENCY " b a.DAILY ❑ b.WEEKLY ❑C.MIN.MONTHLY&EACH TIME SYSTEM OPERATED' 49049 e Allo for momwnn funbuded eme m memwr fuel i onl per HSC 25211.5(61 ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR§2636(a)(3)l. 49x50 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM 490.51 490.5'! ❑ 99.OTHER(Specify) 490.53 UPCF UST-D(12/2007)1/4