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UNDERGROU� STORAGE TANK MON`;ORING PLAN <br /> For use by Unidocs Member Agencies or where approved by your Local Jurisdiction <br /> Authority Cited: Title 23 CCR, Sections 2632(d)(1), 1634(d)(2), and 2641(h) <br /> M01. <br /> TYPE OF ACTION ❑ 1.NEW PLAN ® 2.CHANGE OF INFORMATION M02. <br /> PLAN TYPE ® MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. <br /> (Check one item only) ❑ THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): <br /> I. FACILITY INFORMATION <br /> FACILITY ID#(Agency Use Only) - <br /> MOJ. <br /> FACILITY NAME 7-Eleven#17334 <br /> Y Stot:kto <br /> FACILITY SITE ADDRESS 4507 N. Pershing Moo. CITn M05. <br /> II. EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE <br /> State law requires that testing,preventive maintenance,and calibration of monitoring equipment(e.g.,sensors,probes,line leak detectors,etc.)be performed in M06. <br /> accordance with the equipment manufacturers'instructions,or annually,whichever is more frequent. Such work must be performed by qualified personnel. Mot <br /> MONITORING EQUIPMENT IS SERVICED E 1.ANNUALLY ❑ 99.OTHER(Specify): <br /> III. MONITORING LOCATIONS <br /> This monitoring plan must include a Site Plan showing the general tank and piping layouts and the locations where monitoring is performed(i.e.,location of each sensor, <br /> line leak detector,monitoring system control panel,etc.). If you already have a diagram(e.g.,current UST Monitoring Site Plan from a Monitoring System Certification <br /> form,Hazardous Materials Business Plan map,etc.)which shows all required information,include it with this plan. <br /> IV. TANK MONITORING <br /> MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S):(Check all that apply) M10. <br /> ® 1.CONTINUOUS ELECTRONIC MONITORING OF TANK ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) <br /> SECONDARY CONTAINMENT IS: ® a.DRY b.LIQUID FILLED ❑ c.UNDER PRESSURE ❑ d.UNDER VACUUM MII. <br /> PANEL MANUFACTURER: VeederROOt M11 MODEL#: TLS350 M13. <br /> LEAK SENSOR MANUFACTURER: Veee rROOt Mla MODEL#(S). 794390-420 M15. <br /> ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S) <br /> PANEL MANUFACTURER: M16. MODEL#: MIT <br /> IN-TANK PROBE MANUFACTURER: MIS. MODEL#(S): M19, <br /> LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY M20. <br /> ❑ d.MONTHLY ❑ e.OTHER(Specify): M21. <br /> PROGRAMMED TESTS: ❑ a.0.1 g.p.h. ❑ b.0.2 g.p.h. ❑ c.OTHER(Specify): M22. M23. <br /> ❑ 3.INVENTORY RECONCILIATION ❑ a.MANUAL PER 23 CCR§2646 ❑ b.STATISTICAL PER 23 CCR§2646.1 M24_ <br /> ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)PER 23 CCR§2645 <br /> TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS M25. <br /> ❑ <br /> S.INTEGRITY TESTING PER 23 CCR§2643.1 <br /> TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): M26 M27, <br /> ❑ &VISUAL MONITORING DONE: ❑ e.DAILY ❑ b.WEEKLY(Regnire4 agency avprovl) <br /> M28. <br /> ❑ 99.OTHER(Specify): <br /> V. PIPE MONITORING <br /> MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) Mao. <br /> ® 1.CONTINUOUS ELECTRONIC MONITORING OF PIPING SUMP(S)ITRENCH(ES)AND OTHER SECONDARY CONTAINMENT <br /> SECONDARY CONTAINMENT IS: ® a.DRY ❑ b.LIQUID FILLED ❑ c.UNDER PRESSURE ❑ d.UNDER VACUUM Mn. <br /> PANEL MANUFACTURER:VeederROOt M32. MODEL#: TLS350 M33. <br /> LEAK SENSOR MANUFACTURER: VeederROOt M34. MODEL#(S): 794380-352 M35. <br /> WILL A PIPING LEAK ALARM TRIGGER AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN? ® a.YES ❑ b.NO M36. <br /> WILL FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? ® a.YES ❑ b.NO M37_ <br /> ® 2.MECHANICAL LINE LEAK DETECTOR (MELD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS AND RESTRICTS OR SHUTS OFF <br /> PRODUCT FLOW WHEN A LEAK IS DETECTED <br /> MELD MANUFACTURER(s):Vannriess R Rediacket M38, MODEL#(S): LD2000& FX1V M37. <br /> ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS <br /> ELLD MANUFACTURER: MQ MODEL#: M41. <br /> PROGRAMMED LINE INTEGRITY TESTS: ❑ a.MINIMUM MONTHLY 0.2 g.p.h. ❑ b.MINIMUM ANNUAL 0.1 g.p.h. M42. <br /> WILL ELLD DETECTION OF A PIPING LEAK TRIGGER AUTOMATIC PUMP SHUTDOWN? ❑ a.YES ❑ b.NO M43. <br /> WILL ELLD FAILUREIDISCONNECTION TRIGGER AUTOMATIC PUMP SHUTDOWN? ❑ a.YES ❑ b.NO Ma. <br /> ® 4.INTEGRITY TESTING <br /> TEST FREQUENCY: ® a.ANNUALLY ❑ b.EVERY 3 YEARS [I c.OTHER(Specify) M45. M46. <br /> ❑ 5.VISUAL MONITORING DONE: ❑ a.DAILY ❑ b.WEEKLY- ❑ C.MIN.MONTHLY&EACH TIME SYSTEM OPERATED-- M47 <br /> •Raiiraa agen'approval ••Allowed for monitoring of unburied emmge vy generator fuel piping only per HSC§25281.5(6x3) <br /> ❑ 6.PIPING IS SUCTION PIPING MEETING ALL REQUIREMENTS FOR EXEMPTION FROM MONITORING PER 23 CCR§2636(a)(3) <br /> ❑ 7.NO PRODUCT OR REMOTE FILL PIPING IS CONNECTED TO THE UST(s) <br /> M4g. <br /> ❑ <br /> 99.OTHER(Specify) <br /> UN-022A-1/3 www.unidocs.org Rev.10/14/03 <br />