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UNIFIED PROGRAM CONSOLIDATED FORMW UNDERGROUND STORAGE TANK MONITORING PLAN-(Pse I of 2) TYPE OF ACTION ❑ 1.NEW PLAN 2.CHANGE OF INFORMATION 490.1 PLAN TYPE [] I.MONTTORING 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) 1 BUSINESS NAME(Same as FACILITY NAME) 3 BUSINESS SITE ADDRESSM0 LA-TAO-� 1b3 CITY LA 104 H.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 perforated by qualified personnel. 23 CCR 2632 2634,2638 264! MONITORING EQUIPMENT IS SERVICED IANNUALLY [� 49.OTHER(specify): 490-3■ 490.36 M.MONITORING LOCATIONS ❑L NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. ❑2.SITE PLOT PLANIMAP PREVIOUSLY SUBMIT'T'ED. (23 CCR§2632, 2634)490.4 IV.TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): 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: 'g] a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED ❑d.UNDER VACUUM 490.6 PANEL MANUFACTURER: (Z>1LL 490-7. MODEL#:P 1 00 4904 LEAK SENSOR MANUFACTURER: +/ {LSQQ440'9 MODEL#(S): 4JZD 490-10 2,AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANKISI.(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: ❑ a.CONTINUOUS ❑ b.DAILYINIGHTLY Cl c.WEEKLY 49046 ❑ d.MONTHLY ❑ e.OTHER(Specify): 490.17 PROGRAMMED TESTS: ❑ a.0.1 g.p.h. ❑ b.0.2 g.p.h. ❑ c.OTHER(Specify): 490-18 490-19 ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§1646.1): 4W20 ❑ 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): 490-23 TEST FREQUENCY: a.ANNUALLY 490-24 Q ❑ b.BIENNIALLY ❑ c.OTHER(specify): 490.25 99.OTHER❑ S 490.26( Ii�') 490.21 V.PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) 1.CONTINUOUS MONITORING OF PIPET PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 490.28 VISUAL ALARMS. (23 CCR§2636) SECONDARY CONTAINMENT IS:9a.DRY ❑b.LIQUID FILLED 0c.PRESSURIZED ❑d UNDER VACUUM 490-29 PANEL MANUFACTURER: G I 4ru_v E-PA c- 490'30 I MODEL#:j>AU2.tdiu v- 490.31 LEAK SENSOR MANUFACTURER: V t*,R {-pp T 112 1 MODEL#(S): 2 p 490-33 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(ix,,TURBINE)SHUTDOWN. Z a.YES ❑b.NO 44x34 FAILUREIDISCONNECTION 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 CCR 26 440.36 MILD MANUFACTURER(S): \J M% 490-37 MODEL#(S):t_D2OC10 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) 440.40. MODEL#(S): 49041 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 490-03 ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 490.44 4.PIPE INTEGRITY TESTING 490.45 TEST FREQUENCY a.ANNUALLY b.EVERY YEARS c.OTHERS i 490-46490-47 5.VISUAL PIPE MONITORING. 490.48 FREQUENCY ❑ a.DAILY ❑ b.WEEKLY ❑c.MIN.MONTHLY&EACH TIME SYSTEM OPERATED' 490-49 Allowed for maitanng of unburied emergency eneralor fuel piping only per HSS§Z5281.5@ 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(1212007)114