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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN- Pae 1 of 2) TYPE OF ACTION X.NEW PLAN ❑ 2.CHANGE OF INFORMATION 490-1 PLAN TYPE -WI.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. 490-2 (Check one item only) ❑ 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S) 1. FACILITY INFORMATION FACILITY ID#(Agency Use Only) 1 BUSINESS NAME(Same as FACILITY NAME) r 3 BUSINESS SITE ADDRESS -579 V 0 L7& 11. CITY 104 II.EQUIPMENT VESTING 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 MONITORING EQUIPMENT IS SERVICED ANNUALLY 490-3a Q ❑ 99.OTHER(Specify): 490-3b III.MONITORING LOCATIONS A1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. El 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 2634 90-4 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. J3 CCR§2632,2634) - -SECONDARY CONTAINMENT IS: _❑_ a.DRY b.LIQUID FILLED El c.PRESSURIZED ❑d.UNDER VACUUM 490-6 PANEL MANUFACTURER: - - 490-7. MODEL#:fLf%12-11i-al 490-8 LEAK SENSOR MANUFACTU 490-9. MODEL#(S): 0 a 490.10 2.AUTOMATIC TANK GAUGIN Gj SYSTEM USED TO MO=SINGLE WALL TANK(S).(23 CCR§2643) 490.11 -- PANEL MANUFACTURER: 490-121k V . MODEL#: 49°'13 - ------ ------------------------- IN-TANK PROBE MANUFAC R: V� 490-14 MODELS : 490-15 -- -- ---�# - ------------------------ LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY 490-16 ---- - - - - - -- - - - Q d.MONTHLY ❑ e.OTHER(Specify): 490.17 ------------------------------- PROGRAMMED TESTS: ❑ a.0.1 h. ❑ b.0.2 h. ❑ c.OTHERS cif 490-18 g•P� g•P• (Specify): 490.19 ❑ 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 49°-21 490-22 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 490-23 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) NTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 490-28 SUAL ALARMS. (23 CCR§2636) SECONDARY CONTAINMENT IS:❑a.D IQUID FILLED J11c.PRESSURIZED ❑d.UNDER VACUUM 490-29 PANEL MANUFACTURER: /� #: 490-31 49°3° MODEL LEAK SENSOR MANUFACTURER: 49°32 2-- 490-33 + -- - MODEL#(Sq3�D$- PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE) WN. a.YES ❑b.NO 490-34 FAILURE/DISCONNECTION 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 3 CCR§2636) 490-36 -------------------------------- MLLD MANUFACTURER(S): 490-37 MODEL#(S): 490.38 ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.b.LEAK TESTS (23 CCR§2636) 490-39 ------------------------------ ELLD MANUFACTURER(S) 490.41, PROGRAMMED IN LINE LEAK TEST: ❑ 1.MINIMUM MONTHLY 0.2 g.p.h. ❑ 2.MINIMUM ANNUAL 0.1 g.p.h. 490.42 ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. a.YES ❑b.NO 490.43 ELLD FAILUR.E/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. YES ❑b.NO 490.44 ❑ 4.PIPE INTEGRITY TESTING 49045 TEST FREQUENCY ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(Specify) 490-46490-07 ❑ 5.VISUAL PIPE MONITORING. 490-48 FREQUENCY ❑ a.DAILY ❑ b.WEEKLY ❑c.MIN.MONTHLY&EACH TIME SYSTEM OPERATED' 49049 'Allowed for monitoring of unburied emergency enerator fuel piping only r HSC 25281.5 3 ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR§2636(a)(3)I. 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 49x53 10�°� � �1. �. UPCF UST-D(1212007)1/4 ��