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001198 UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN-(Pae 1 of 2 TYPE OF ACTION ❑ I.NEW PLAN 9 2.CHANGE OF INFORMATION 490E PLAN TYPE I MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. 4WZ (Check one item only) [12.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): 1. FACILITY INFORMATION FACILITY ID#(Agency Use Only) BUSINESS NAME(Sane as FwUay Name a DBA) a BUS SITE ADDRESS 109. CITY loe. H. EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE testing,preventive maintenance,and calibration of monitoring equipment(e.g.,sensors,probes,line leak detectors,etc.)most be performed a<the frequency specified by the nent manufactucrs'instiuctiont,or annually,whichever is mom frequent.Such work must be performedby gualified persmtcel.In cCR ju 2.zas4,zwe_26et MONITORING EQUIPMENT IS SERVICED L ANNUALLY ❑ 99.OTHER(Specify): a W III. MONITORING LOCATIONS ❑ t NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN , 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED [23 ccn 42wz zw41 49x4. IV. TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) 111their 1call 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) 490.5. WITH AUDIBLE AND VISUAL ALARMS.In CCR;2632,zwal SECONDARY CONTAINMENT IS: ❑ a.DRY b.LIQUID FILLED ❑ c.PRESSURIZEDT- F,T�i d.UNDER VACUUM 490'6' URER PANEL MANUFACT490'2" MODEL#: I Ii.] '� 3 .S�(� 09041' LEAK SENSOR MANUFACTURER: - 4909. MODEL#S): 3 49o3a ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANKIS).[n cak fu j 49au. PANEL MANUFACTURER: °9031 MODEL#: 49o-t3. IN-TANK PROBE MANUFACTURER: 490'!4' MODEL#(S): 490-15. LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY c.WEEKLY 490'1&. ❑ d.MONTHLY ❑ e.OTHER(Specify): 49 H. PROGRAMMED TESTS: ❑ a 0ABP.n. ❑ b.0.2 g.Rh. El c. c.OTHBR(Specify): 4903v ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION in cert j a rj ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)(n CCR 426451 TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS 490.21, _ 490-22 ❑ 5.TANK INTEGRITY TESTING PER In CCR 42&&3.0 a90a3. _ TEST FREQUENCY- ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHERS 49N. (Specify): ±2M.5 49 X ❑ 99.OTHERS i 49°m. ll V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) Ih`i My) I CONTINUOUS MONITORING OF PU'E/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE&VISUAL ALARMS. 690. j SECONDARY CONTAINMENT IS V&DRY ❑ b.LIQUID PILLED ❑ c.PRESSURIZED ❑ d UNDER VACUUM 490.2E . PANEL MANUFACTURER: II(g_E . P 49w0 '7�(xZT MODEL#: " -O 49033. LEAK SENSOR MANUFACTURER: ✓E E nC'r-- ' � 49032 MODEL#(S): - 49o3s' PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. a.YES ❑ b.NO °9034' FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. We.YES ❑ b.NO 490.3'' ® 2.MECHANICAL LINE LEAK DETECTOR(MLLD)THAT ROUTINELY PERFORMS 3.0 gp.h.LEAK TESTS AND RESTRICTS OR SHUTS OFF 40'36. PRODUCT FLOW WHEN A LEAK IS DETECTED.rya ccRgm361 `l MLLD MANUFACTURER%): F_ ..r ke.4IjMODEL#(S): 4903& ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROU TNELOV PERFORMS 3.0 g.p.tL LEAK TESTS.[n ccitimmi -M09 M I D MANUFACTURER(S): 19P40" MODEL#(S): 49641 PROGRAMMED IN LINE LEAK TEST: ❑ a MINIMUM MONTHLY 0.2 gp.h. ❑ b.MINIMUM ANNUAL 0.1 g.p.h. 49012. ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ❑ b.NO ELLD FAILURENISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a YES ❑ b.NO 490.44 ❑ 4.PIPE INTEGRITY TESTING. 49 5. TEST FREQUENCY: ❑ a ANNUALLY [Ib.EVERY 3 YEARS [3 a OTHER(Specify) &son 490.1&_ ❑ 5.VISUAL PIPE MONITORING. 4904& FREQUENCY' ❑ &DAILY ❑ b.WEEKLY ❑ C.MIN.MONTHLY&EACH TIME SYSTEM OPCRATED' 490'49 _ •Albrad rw�ro or nbvioJ nd oN HSC 2sn3.56 �.._.._ ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA.(n acR 4266 4p)I a9oso ❑ 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM. ❑ 99.OTHER 5 ecify) a9asz 490.53. UPCF UST-D(1212007) 1/4 www.uWocs otq