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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN- Page I at 2) TYPE OF ACTION 1.NEW PLAN ❑ 2.CHANGE OF INFORMATION 490'1 PLAN TYPE fl[ 1 MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. 490-2 (Check one item only) ❑ Z THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S) I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) 1 BUSINESS NAME(Same as FACILITY NAME) G fdt�f��i Sn✓e l t� 3 BUSINESS SITE ADDRESS/ZGfd 4,f"e IV 103 CITY) �,fr IL 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'2632,2634,2638,264 1) x90-3a MONITORING EQUIPMENT IS SERVICED ❑ 1.ANNUALLY ❑ 99.OTHER(Specify): 490-3b III.MONITORING LOCATIONS ❑ 1.NFNN'SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN.❑2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 263.4),1vo_I IV.TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): I 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: Ly a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED ❑d.UNDER VACUUM 490"6 PANEL MANUFACTURERS - / _/Gd - - - M - � 490-7 �""- --__ 490-$ LEAK SENSOR MANUFACTURER: - - - --------__ . /, d a9o_9. MODEL#(S): 1A7r� ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM 1JSED TO MONITOR SINGLE WALL TANK(S).(23 CCR§2643) 490-11 PANEL MANUFACTURER: a9a12. M_ ODEL#: 490-13 --- - - ----------------------- ----------------- ---------- ------------- -------------------- - -- -_ -- 490-14.-"-IN-TANK PROBE MANUFACTURER_,---__-"----�--_-_ _ MODEL#(S): 490-I5----- ------------- --- LEAK TEST FREQUENCY: ❑ a.CONTINUOUS --"- - ,WEEKLY -49fC Q ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY ------ --- _ El-d.-MONTHLY ❑ e.OTHER(Specify): 490-17 - - - - -- -- ---- - ------- - - ----- - - -- --- PROGRAMMED TESTS: ❑ a.0.1 h. ❑ b.0.2 h. 490.1$ g.p.h. g.p.h. ❑ c.OTHER(Specify): 490-I9 ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 490-20 ❑ 4,WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§2645). TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS 490.21 490-22 ❑ 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 49x23 TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): 490-24 490-25 ❑99.OTHER (Specify): 490-26 490-27 V.PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) CN I.CONTINUOUS MONITORING OF PIPE)PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 490-28 VAUAL ALARMS. (23 CCR§2636) SECONDARY CONTAINMENT IS:XDRY ❑b.LIQUID FILLED ❑c.PRESSURIZED ❑d.UNDER VACUUM 490-29 T490.30 1 PANEL MANUFACTURER: r- fir f�,yY" I MODEL#: �' �j 5rj T 490 31 LEAK SENSOR MANUFACTURER: 1 _ 440"32 -MODEL#(S): 490-31 - -- - -- - - -- -- - - 0 L _-----""---- PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN, ❑a.YES ❑N NO 490-34 FAILUREMISCONNECTION 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 PETECTED(23 CCR 12636) 490-36 MLLD MANUFACTURER(S): !fir r -- 493-37 MODEL#(S): y� d� a9o_a$ ❑ 3,ELECTRONIC LINE LEAK DETECTOR LLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS (23 CCR§2636) 490-39 ELLD MANUFACTURER(S) 490-x0 MODEL#(S) 490-41 ---- - - ---- --- - - --- - - - -_--- PROGRAMMED IN LINE LEAK TEST: ❑ L MINIMUM MONTHLY 0.2 g.p.h. ❑ 2-MINIMUM ANNUAL 0.1 g.p.h- 450-42 ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 490-43 ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b,NO 490-44 ❑ 4.PIPE INTEGRITY TESTING 49045 TEST FREQUENCY ❑ a,ANNUALLY ❑ b,EVERY 3 YEARS ❑ c.OTHER(Specify) 490-46490-47 ❑ 5.VISUAL PIPE MONITORING. x90-4$ FREQUENCY ❑ a.DAILY ❑ b.WEEKLY ❑c.MIN.MONTHLY 8r EACH TIME SYSTEM OPERATED' 49049 "Allawvd for rnontton of mbuned emergency enerator Fuel pipmg only er HSC§252$1 5(by(3) ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR§2636(a)(3)]. 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(1212007)114