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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN-(Page 1 of 2) 490-1 TYPE OF ACTION ❑1.NEW PLAN 2.CHANGE OF INFORMATION PLAN TYPE 1.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. 490-z (Check one item only) ❑ 2.=THIS COVERS ONLY THE FOLLOWING UST SYSTEM(S)' I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) - - 1 BUSINESS NAME(Same as FACILITY NAME) �02�- SSP 10oo /)1 Al2 7 3 BUSINESS SITE ADDRESS 20 V✓ 7-L 2",C11 k a .'!z` �-. r03 CITY �Di � .. I0°. H.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 MONITORING EQUIPMENT IS SERVICED 1.ANNUALLY ❑ 99.OTHER(Specify): 4%-3c ( P fy)� 490-3b IH.MONITORING LOCATIONS .NEW SITE PLOT PLANIMAP SUBMITTED WITH THIS PLAN. 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 634 904 IV.TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S):. 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT 450-5 VAULT(S)WITH AUDIBLE AND VISUAL A S. (23 CCR§2632,2634) SECONDARY CONTAINMENT IS: a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED ❑d.UNDER VACUUM 490-6 PANEL MANUFACTURER: L L 3.$y ✓'EE,DE/'I 40w7- 490-1' MODEL#: �`6 Z 90- O 22- 49aa LEAK SENSOR MANUFACTURER: [/eED&A /1007 4909. MODEL#(S): e V_3 %0- C/2_0 45x10 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).(23 CCR§2643) 450-11 PANEL MANUFACTURER: 490-12. MODEL#: 490-13 IN-TANK PROBE MANUFACTURER: 490-14. MODEL S): 490-[5 .DAI LEAK TEST FREQUENCY: Ka.CONTINUOUS r/Sr�9-�' LY/NIGHTLY ❑ c.WEEKLY 49546 ❑ d.MONTHLY ❑ e.OTHER(Specify): _ 490-19 ❑ a.0.1 h. ❑ b.0.2 h. ❑ c.OTHERS i 4WIa PROGRAMMED TESTS: g.p.h. g& (Specify): 490-15 ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 490-20 El4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§2645). TESTING PERIOD: [Ia.36 HOURS Elb.60 HOURS 490-v 490-22 ❑ 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 490-21 TEST FREQUENCY: Ela.ANNUALLY [Ib.BIENNIALLY [Ic.OTHER(Specify): 4�u El99.OTHER (Specify): 490-26 490.21 V.PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) .CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 490-28 VISUAL ALARMS. (23CCR§2636) - SECONDARY CONTAINMENT IS:❑a.DRY ❑b.LIQUID FILLED ❑c.PRESSURIZED ❑d.UNDER VACUUM 495-29 PANEL MANUFACTURER: QEit csTJ T 450-30 MODEL#: 812 O^ 6:2-.2 495x1 LEAK SENSOR MANUFACTURER: 490-33 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. ❑a.YES ❑b.NO 490-34 F ISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 490`35 .MECHANICAL LINE LEAK DETECTOR(M LLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS AND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK IS DETECTED 23 CCR263 49x36 MLLD MANUFACTURER(S): k"/�-� /2 E/- J,4C,,�ET 490.31 MODEL#(S): Zov X ,� 490-3s ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELM)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS (23 CCR§2636) 49x39 ELLD MANUFACTURER(S) 490.45' MODEL#(S): 49041 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 FAD.URE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a YES ❑b.NO 495'0 ❑ 4.PIPE INTEGRITY TESTING 49o-is TEST FRE UENCY ❑ a.ANNUALLY b.EVERY 3 YEARS ❑ c.OTHER S a 45016490x1 FREQUENCY AILY ❑ b.WEEKLY ❑c.MB4.MONTHLY&EACH TQv/E SYSTEM OPERATED' 490.49 •Allowed for movi afw 'ed eme m cruor fuel i ' od HSC 25281.5(b 3 ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA[23 CCR§2636(a)(3)]. P1=rJ=1Mr1 sa 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNE SIMEM 490-51 [199.OTHER(Specify) F 19 2n14 g 490-52 U 490-53 ENVIRONMENTAL HEALTH DEPARTMENT UPCF UST-D(12/2007)1/4