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UNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANK <br /> MONITORING PLAN- (Page I of 2) <br /> 141-1 <br /> TYPE OF ACTION I. EW PLAN ❑ 2.CHANGE OF INFORMATION 4n2 <br /> PLAN TYPE I MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. <br /> (Check one item only) ❑ 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): <br /> I. FACILITY INFORMATION <br /> FACILITY ID#(Agency Use Only) 1 <br /> BUSINESS NAME(Same as Faei(inr ppgA) 3 <br /> BUSINESS SITE ADDRESS . <br /> 101- CITY Cd-e'\ - i Zy/yen <br /> II. EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE <br /> Testing,preventive maintenance,and calibration of monitoring equipment(eg.,sensors,probes,line leak detectors,etc.)must be performed at the frequency specified <br /> by the equipment manufacturers'instructions,or annually,whichever Istore_fr_eguent Such work mus[be performed by qualified Personnel I'-3 CCR,4263 61a.,2n3s.2WI <br /> MONITORING EQUIPMENT IS SERVICED I ANNUALLY ❑ 99.OTHER(Specify) +90-30- <br /> pemfY)' 49a-3b. <br /> III. MONITORING LOCATIONS <br /> I_NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN ❑ 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED 123 CCR§2132,2041 4%4 <br /> IV. TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) „Caheack all <br /> fffl.CONTINUOUS ELECTRONIC TANK MONITORING OIANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) 441-5. <br /> WITH AUDIBLE AND VISUAL ALARMS.123' §'263_11341 <br /> SECONDARY CONTAINMENT IS ` a.DRY ❑ b. UID FILLED ❑ d.UNDER VACUUM 490 ' <br /> � /' A J,I(2 ❑ c.PRESSURIZED <br /> PANEL MANUFACTURER: I C. -KQ� 490-7' MODEL#: / s0 490-8. <br /> LEAK SENSOR MANUFACTURER I= V4tJ6W-X40" 4909- MODEL#(S):0 7 12 3 T 49 Z4 "' <br /> ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).In CCR 126431 490-11, <br /> PANEL MANUFACTURER: 49012 MODEL#: 490'1 <br /> IN-TANK PROBE MANUFACTURER 490-14- MODEL#(S): 49 15. <br /> LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY 490.16. <br /> ❑ d.MONTHLY ❑ e.OTHER(Specify): 490.1. <br /> PROGRAMMED TESTS: ❑ a.0.19. h_ ❑ b.0.2 g.p.h. ❑ c.OTHER(Specify): 490-1& <br /> 490.19. <br /> ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION 1x1 ccR 6x646 0 49020. <br /> ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)1x3 CCR 426451 TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS490"21. <br /> 49 22, <br /> ❑ 5.TANK INTEGRITY TESTING PER 123 ccit4x643.11 49023. <br /> TEST FREQUENCY: _ Q a.ANNUALLY ❑ b.BIENNIALLY 0 c.OTHER(Specify): 45Y490-26 <br /> C199.OTHER(Specify): _ -_ 49026 <br /> 4427 <br /> V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) fah�ck all <br /> I.CONTINUOUS MONITORING OF PIPEIPIPING$NMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE&VISUAL ALARMS. 4900-8. <br /> Iv cel SECONDARY CONTAINMENT a.DRY ❑ c.PRESSURIZED ❑ d.UNDER VACUUM 44429. <br /> ,4x6361 [S `s_ i❑ b%I UID FILLED 490-30. <br /> PANEL MANUFACTURER. V GG �//�/-+�'�� 94 - MODEL#: SGS 3'S� 490'31. <br /> LEAK SENSOR MANUFACTURER: _ 490-12. MODEL#(S): � 't 490-33. <br /> PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. gkoh.YES ❑ ;'NO 490-34. <br /> FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. �.YES ❑gb.NO 49035. <br /> 2.MECHANICAL LINE LEAK LEAK <br /> IS R(MELD)THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS AND RESTRICTS OR SFJUT OFF 49a­1(i <br /> PRODUCT FLOW WHEN A LEAK IS ETF,CTE .I x6361 Ole / \ /K'r' /i4^/r' <br /> MLLD MANUFACTURER(S): A �� 49037. MODEL#(S):NL Z Y0's. <br /> ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELL )THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS.t23 cemm:isl +9039. <br /> ELLD MANUFACTURER(S): 49040 MODEL#(S): 490-11_ <br /> PROGRAMMED IN LINE LEAK TEST: ❑ a.MINIMUM MONTHLY 0.2 g.p.h. ❑ b.MINIMUM ANNUAL 0.1 g.p.h. 49042. <br /> ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ❑ Is.NO 49 3, <br /> ELLD FAILUREIDISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ❑ b.NO 49 <br /> ❑ 4.PIPE INTEGRITY TESTING. 49 15 <br /> TEST FREQUENCY: ❑ a.ANNUALLY ❑ Is.EVERY 3 YEARS ❑ c.OTHER490.46 <br /> (Specify) 49047. <br /> ❑ 5.VISUAL PIPE MONITORING. 4964& <br /> FREQUENCY: ❑ a,DAILY ❑ Is.WEEKLY ❑ C.MIN,MONTHLY&EACH TIME SYSTEM OPERATED* 49009, <br /> •Allawclfm_insinn vof u�bunM_e13xr�mcv¢mwvor f-1pipi. M per xsC 125281.5b <br /> ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA.123 CCR g2636(.y3)] 49050. <br /> ❑ T.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM. 490-51 <br /> ❑ 99.OTHER(Specify) 49 3z <br /> 49x53. <br /> UPCF UST-D(12/200')-1/4 www.unidocs.org <br />