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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN- Page 1 of 2) TYPE OF ACTION ❑ L NEW PLAN ❑ 2.CHANGE OF INFORMATION 490-1 PLAN TYPE ❑ I.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) I I -TI I I I I I1 3. BUSINESS NAME(Same as FACILITY NAME) BUSINESS SITE ADDRESS 1O1_ CITY 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 490.34 MONITORING EQUIPMENT IS SERVICED ❑ L ANNUALLY ❑ 99.OTHER(Specify): 490-36 III.MONITORING LOCATIONS ❑1.NEW SITE PLOT PLANIMAP SUBMITTED WITH THIS PLAN. ❑2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 2634)490-1 IV.TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): I.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT 4%-5 VAULT(S)WITH AUDIBLE AND VISUAL ALARMS. (23 CCR§2632,2634) SECONDARY CONTAINMENT IS: ❑ a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED ❑d.UNDER VACUUM 490'6 PANEL MANUFACTURER: 490.1 MODEL#: 4908 LEAK SENSOR MANUFACTURER: 490.9. MODEL#(S): 49x10 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).(23 CCR§2643) 490-11 PANEL MANUFACTURER: as°-1z. MODEL#: 49x13 IN-TANK PROBE MANUFACTURER: x90-14. MODEL#(S): 49x15 LEAK TEST FREQUENCY: ❑ &CONTINUOUS ❑ b.DAILYINIGHTLY ❑ c.WEEKLY 490-16 ❑ d.MONTHLY ❑ e.OTHER(Specify): 490.17 PROGRAMMED TESTS: ❑ a.0.1 g.p.h. ❑ b.0.2 g.p.h. ❑ c.OTHER(Specify): 496 90 9 ❑ 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): 490-23 TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): 4990--x294 49°-26 ❑99.OTHER (Specify): 490-27 V.PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) ❑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:❑a.DRY ❑b.LIQUID FILLED ❑c.PRESSURIZED ❑d.UNDER VACUUM 490-29 PANEL MANUFACTURER: 090.10 MODEL#: 490.31 LEAK SENSOR MANUFACTURER: 690az MODEL#(S): 490-11 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. ❑a.YES ❑b.NO 490-34 FAILUREIDISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 090-35 ❑ 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 2636 490-36 MILD MANUFACTURER(S): 490.37 MODEL#(S): 49x38 ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS (23 CCR§2636) 490-39 11 ELLD MANUFACTURER(S) °9000 MODEL#(S): 49041 PROGRAMMED IN LINE LEAK TEST: ❑ I.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 F1 b.NO 49043 ELLD FAILUREIDISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 490� 4.PIPE INTEGRITY TESTING 490.45 TEST FREQUENCY a.ANNUALLY El b.EVERY 3 YEARS c.OTHER(Specify) 49046490-47 5.VISUAL PIPE MONITORING, 49048 FREQUENCY ❑ a.DAILY ❑ b.WEEKLY ❑C.MIN.MONTHLY&EACH TIME SYSTEM OPERATED- 490-49 *Allowed for mnitonng ofwbuned emagwcy gmans.,fuel Pima onl ,HSC§252815b 3) ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA(23 CCR§2636(x)(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 49052 ❑ 99.OTHER(Specify) 490.53 UPCF UST-D(12/2007)114