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T . UNDERGROA STORAGE TANK MONIPORING PLAN For use by Unidocs Member Agencies or where approved by your Local Jurisdiction e„fh.,,./t„ Cited- Title 23 CCR. Sections 2632(d)(1), 2634(d)(2), and 2641(h) ❑ 99. OTHER (Specify) UN -022A -1/3 www.unidocs.org Rev. 10/14/03 M01. TYPE OF ACTION ❑ 1. NEW PLAN ® 2. CHANGE OF INFORMATION M02, PLAN TYPE ® MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. (Check one item only) ❑ THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): I. FACILITY INFORMATION FACILITY ID # (Agency Use Only) M03. FACILITY NAME 7-EI@V@rI #32190 Moa. CITY $tOCktOrl FACILITY SITE ADDRESS 49435. iCIf1Q51@y MOS. II. EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE State law requires that testing, preventive maintenance, and calibration of monitoring equipment (e.g., sensors, probes, line leak detectors, etc.) be performed in Such work must be by qualified personnel. M06. accordance with the equipment manufacturers' instructions, or annually, whichever is more frequent. performed M07. MONITORING EQUIPMENT IS SERVICED ® L ANNUALLY ❑ ecify): III. MONITORING LOC IONS This monitoring plan must include a Site Plan showing the general tank and piping layouts and th ocations where monitori g is performed (i.e., location of each sensor, UST Monitoring Site Ian from a Monitoring System Certification line leak detector, monitoring system control panel, etc.). If you already have a diagram (e.g., cu en form, Hazardous Materials Business Plan map, etc.) which shows all re uired information, include it th this Ian. IV. TANK MONITORI G M10 IS PERFORMED USING THE FOLLOWING METHOD(S): (Check all that apply) MONITORING ® 1. CONTINUOUS ELECTRONIC MONITORING OF TANK ANNULAR TERSTITIAL) SP E(S) OR SE ONDARY CONTAINMENT VAULT(S) Mll SECONDARY CONTAINMENT IS: 11a. DRY ®b. LIQ FILLED ❑ a UNDE RESSURE ❑ d. UNDER VACUUM Mu PANEL MANUFACTURER: V @r O 12. DEL#: TI 5350 M14. 79438!-302 MI5. ODEL#(S): LEAK SENSOR MANUFACTURER: Vee rR0 t - ❑ 2. AUTOMATIC TANK GAUGING (ATG) SYSTEM USED TO MONITOR SIN LE WALL TA m K MI] PANEL MANUFACTURER: MODEL#: M18. M19. IN -TANK PROBE MANUFACTURER: MODEL#(S): b. DAILY/NIGHTLY ❑ c. WEEKLY Mzo. LEAK TEST FREQUENCY: ❑ a. CONTINUOUS M21. d. MONTHLY ❑ e. OTHER (Specify): M22 M23, PROGRAMMED TESTS: a. 1 g.p.h. ❑ b. 0.2 g.p.h. 11c. OTHER (Specify): Mzo. El 3. INVENTORY RECONCILIATION a. M AL PER 23 CCR §2646 ❑ b. STATISTICAL PER 23 CCR §2646.1 ❑ 4. WEEKLY MANUAL TANK GAUG G (MTG) ER 23 CCR §2645 M25 TESTING PERIOD: a. 36 HO RS ❑ b. 60 HOURS ❑ 5. INTEGRITY TESTING PER 23 CCR §2643.1 M26, M27, TEST FREQUENCY: a. ANNU LLY ❑ b. BIENNIALLY ❑ c. OTHER (Specify): ❑ 6.VISUAL MONITORING DONE: a. DAILY ❑ b. WEEKLY(RI.i. usurer aPProral) M28 Specify): ❑ 99.OTHER V. PIPE MONITORING M39, MONITORING IS ERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply) ® 1. CONTINUO S ELECTRONIC MONITORING OF PIPING SUMP(S)ITRENCH(ES) AND OTHER SECONDARY CONTAINMENT M31 SECOND RY CONTAINMENT IS: ® a. DRY ❑ b. LIQUID FILLED ❑ c. UNDER PRESSURE ❑ d. UNDER VACUUM M33. PANEL NUFACTURER:V@@d@rROOt2' MODEL#: T15350 A134 794380-208 M35. LEAK SEN RMANUFACTURER: V@@d@rROOt MODEL #(S): a. YES ❑ b. NO M35. WILL A PIP G LEAK ALARM TRIGGER AUTOMATIC PUMP (i.e., TURBINE) SHUTDOWN?® M37. WILL FAILU /DISCONNECTION OF THE MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? R ® RIOTS OR SHUTS OFF ❑ 2. M ICAL L E LEAK DETECTOR (MLLD) THAT ROUTINELY PERFORMS 3.0 g.p. . LEAKPROD FLOW HEN A LEAK IS DETECTED M38.MODEL #(S): PI I D M39. MLLD ACTURER(s): VagQrl@55 LEAK DETECTOR (ELLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS ® 3. ELECTRONIC LINE M40 MODEL #: M41. ELLD MANUFACTURER: LINE INTEGRITY TESTS: ❑ a. MINIMUM MONTHLY 0.2 g.p.h. ❑ b. MINIMUM ANNUAL 0.1 g.p.h. M41. M43. PROGRAMMED WILL ELLD DETECTION OF A PIPING LEAK TRIGGER AUTOMATIC PUMP SHUTDOWN? ❑ a. YES ❑ b. NO M44. WILL ELLD FAILUREIDISCONNECTION TRIGGER AUTOMATIC PUMP SHUTDOWN? ❑ a. YES ❑ b. NO ® 4. INTEGRITY TESTING M45. M"6 TEST FREQUENCY: ® a. ANNUALLY ❑ b. EVERY 3 YEARS ❑ c. OTHER (Specify) C. noONTHLY & nCH TIME SYSTEMO� ❑ DAILY ❑b.WEB�vt ❑ S.VISUAL MONITORING DONE: a. ,.❑ Rnen 1MY Allow for moring of enneigey germtor fi'eIP�"B y prSC§5281.5(b)(3) ❑ 6. PIPING IS SUCTION PIPING MEETING ALL REQUIREMENTS FOR EXEMPTION FROM MONITORING PER 23 CCR §2636(a)(3) ❑ 7. NO PRODUCT OR REMOTE FILL PIPING IS CONNECTED TO THE UST(s) M48. ❑ 99. OTHER (Specify) UN -022A -1/3 www.unidocs.org Rev. 10/14/03