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UNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANK <br /> MONITORING PLAN- Pae 1 of 2) <br /> TYPE OF ACTION I.NEW PLAN ❑ 2.CHANGE OF INFORMATION 490.1 <br /> PLAN TYPE ❑ 1.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. 490'2 <br /> (Check one item only) ❑ 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S) <br /> I. FACIIdTY INFORMATION <br /> FACILITY ID k(Agency Use Only) <br /> BUSINESS NAME(Same as FACILITY NAME) 3' <br /> AMMEbs NC /I1/c <br /> BUSINESS SITE ADDRESS +ISJ C- M;T v, 103. CITY �'7T C A- 95' 10° <br /> II.EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE J <br /> Testing,preventive maintenance,and calibration of monitoring equipment(e.g.,sensors,probes,line leak detectors,etc.)must be performed at the frequency <br /> specified by the equipment manufacturers'instructions,or annually,whichever is more frequent,and that such work must be performed by qualified personnel. <br /> 23 CCR 2632 2634,2638 2641 <br /> MONITORING EQUIPMENT IS SERVICED PPL ANNUALLY ❑ 99.OTHER(Specify): aw 3n <br /> III.MONITORING LOCATIONS <br /> [11.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. W 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, <br /> 2634)4964 <br /> IV.TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): <br /> 10 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT 4965 <br /> VAULT(S)WITH AUDIBLE AND VISUAL ALARMS. (23 CCR§2632,2634) <br /> SECONDARY CONTAINMENT IS: a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED ❑d.UNDER VACUUM 49x6 <br /> PANEL MANUFACTURER: °90-3' MODEL 0: TLS 3 4908 <br /> LEAK SENSOR MANUFACTURER: 490-9' MODEL#(S): 20A 49010 <br /> 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(Sl.(23 CCR§2643) 49x11 <br /> PANEL MANUFACTURER: 49612. MODEL 0: 490.13 <br /> IN-TANK PROBE MANUFACTURER: 490-14. MODEL$(S): 490.15 <br /> LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ C.WEEKLY 49616 <br /> ❑ d.MONTHLY ❑ e.OTHER(Specify): 49613 <br /> PROGRAMMED TESTS: ❑ a.0.1 g.p.h. ❑ b.0.2 g.p.h. ❑ c 490-19 OTHER(Specify): 49619 <br /> ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 49620 <br /> ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§2645). TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS 490-21 <br /> 49622 <br /> 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 49623 <br /> TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): 49624 <br /> 49x25 <br /> ❑99.OTHER (Specify). 390.26 <br /> V.PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) <br /> I.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 49o-u <br /> SUAL ALARMS. (23 CCR§2636) <br /> SECONDARY CONTAINMENT IS: a.DRY ❑b.LIQUID FILLED ❑c.PRESSURIZED ❑d.UNDER VACUUM 49629 <br /> PANEL MANUFACTURER: °9030 MODEL M: L, ,rO 490-31 <br /> LEAK SENSOR MANUFACTURER: ° 490-32 MODEL g(S): oD 49633 <br /> PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. ❑a.YES ❑b.NO 4WM <br /> FAILUREMISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 49635 <br /> 2.MECHANICAL LINE LEAK DETECTOR(MLLD)THAT ROUTINELY PERFORMS 3.0 g.pJL LEAK TESTS AND RESTRICTS OR SHUTS OFF <br /> PRODUCT FLOW WHEN A LEAK IS DETECTED 23 CCR 2636 49636 <br /> MLLD MANUFACTURER(S): 490.31 MODEL 0(S): 49639 <br /> 3.ELECTRONIC LINE LEAK DETECTOR ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS (23 CCR§2636) 49039 <br /> ELLD MANUFACTURER(S) °9O'0o MODEL p(S): L h °9041 <br /> PROGRAMMED IN LINE LEAK TEST: ❑ I.MINIMUM MONTHLY 0.2 g.p.h. ❑ 2.MINDAUM ANNUAL 0.1 g.p.h. 49603 <br /> ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑It.NO °96°3 <br /> ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 49644 <br /> El 4.PIPE INTEGRITY TESTING 490-05 <br /> TESTFPEQUENCY 0 a ANNUALLY 0 b.EVERY 3 YEARS c.OTHERS i 49 0.16 49 6 4 7 <br /> 5.VISUAL PIPE MONITORING. 490-09 <br /> FREQUENCY ❑ a.DAILY ❑ b.WEEKLY ❑o.MIN.MONTHLY h EACH TIME SYSTEM OPERATED- 49049 <br /> 'Mimdfm, ton ofmbmie gm rn wfu i'n as HSC 252815 3 <br /> ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR§2636(a)(3)1. 49650 <br /> 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.715 CONNECTED TO THE TANK SYSTEM <br /> 49651 <br /> ❑ 99.OTHER(Specify) 49052 <br /> 49653 <br /> UPCF UST-D(12/2007)114 <br />