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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 5a 2.CHANGE OF INFORMATION a9o-2. PLAN TYPE t$I 1.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. (Check one item only) ❑ 2,THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) r A D 0 -7 '7 1 1. �1 3. BUSINESS NAME(Same as Facility Nome or DBA) 1wes �P BUSINESS SIT ADD SS 103 CITY �• , te.4-re .aOC . 7T• tYl �' II. EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE Testing,preventive maintenance,and calibmtion of monitoring equipment(e.g.,sensors,probes,line leak detectors,etc.)most be performed at the frequency specified by the e�C uipmemt manufacturers'instructions,or annually,whicheve[is more vent.Such work must be.performed- .bygualifreAQersonnel: ccxgw3z2,zfi3a,z63s4 3i MONITORING EQUIPMENT IS SERVICED CIC1.ANNUALLY ❑ 99.OTHER(Specify): 490.3b III. MONITORING LOCATIONS ❑ 49O4 1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN El 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED 123 CCR§2632.26341 " IV. TANK MONITORING IS PERFORMED USING THE FOLLOWING METHODS (check all thatapply) 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(IN'T'ERSTITIAL)SPACES)OR SECONDARY CONTAINMENT VAULT(S) &90.5 WITH AUDIBLE AND VISUAL ALARMS.[23 CCR W32.263a1 490-6 SECONDARY CONTAINMENT IS: ® a.DRY fa31 b.LIQUID FILLED ❑ c.PRESSURIZED ,,77 ❑ d.UNDER VACUUM 490.7. MODEL#: (A ZC h C 4W8. PANEL MANUFACTURER: ' I Lai Y:27 C/o i- 4so-lo LEAK SENSOR MANUFACTURER: - - .I 39nA MODEL#(S) "__.._____.__-__-_--__.. 490.11. ❑ 2.AUTOMATIC TANK GAUGING(ATG) S EM USED TO MONITOR SINGLE WALL TANK(S).4g3 CCk§2WI 090,0, PANEL MANUFACTURER: MODEL#: IN-TANK PROBE MANUFACTURER: 390'14 MODEL#(S): 59&15. LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY 490-1& 90.17. ❑ d.MONTHLY [Ie.OTHER(Specify): 49 1& PROGRAMMED TESTS D,a 01-.gbh._ _ .0 602gph _.(] c_OT[�SQecify): . a90,2o. ❑ 3.MONTFll.Y STATISTICAL 1lWENTORY RECONCILIATION R3 cca 426+6 q_____ _ _ ._._ _ ___ ..._.___ _._ -" -- TESTING PERIOD: a.36 HOURS ❑ b.60 HOURS 491Fun ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)Iz3 CCR§zw51 _..__.__--._______ ❑ 5.TANK INTEGRITY TESTING PER Iv ccR 40,&3.11 490,24 TEST FREQUENCY: El a_ANNUALLY0 b.BIENNIALLY El. MR ify$ _a90,zs__-_ .. 490-26. ❑ 99.DINER(Specify): 490.27. (Chec V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) (2h k/o!! ❑ 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE&VISUAL ALARMS. 123 CCR49 19. §x6361 SECONDARY CONTAINMENT IS: [X1 a.DRY ❑ b.LIQUID FILLED ❑ u PRESSURIZED ❑ d.UNDER VACUUM PANEL MANUFACTURER: rl) I3;'I^Ct °90.30 MODEL#: F'/3 C� 1_)C%�-- 490.31. 49 31 MODEL#(S): LIT Ac-2J0 490-33. LEAK SENSOR MANUFACTURER: 1 M[:1`t CT 490,34. PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e..TURBINE)SHUTDOWN. ❑ a.YES ❑ b.NO FAILUREIDISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ❑ b.NO 490-33. __..____.___" ._."_ _-__.__.._._-__..-__..".".____-__"___..-________-..____. 490-36. ❑ 2.MECINANICAL LINE LEAK DETECTOR(MELD)THAT ROUTINELY PERFORMS 3.0 g.p.b.LEAK TESTS AND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK IS DETECTED.(23 ccRWml 49011 490-38. LLD MANU490-39. ELEC MFACTURER(S): MODEL#(S): . _ ❑ 3. TRONIC LINE LEAK DETECTOR(FLED)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS.123 ccR§u361 4vor1 ELLD MANUFACTURER(S): 4904& MODEL#(S): PROGRAMMED IN LINE LEAK TEST: ❑ a.MINIMUM MONTHLY 0.2 g.p.h. ❑ b.MINIMUM ANNUAL 0.1 gP h. 49&42. ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ❑ b.NO 490,.13. ELLD FAILUREDISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ &YES ❑ b.NO 490°4 ❑ 4.PIPE INTEGRITY TESTING. 490.46. TESTFREQUENCY: 0 a.ANNUALLY 0 b.EVERY YEARS ❑ c.OTHER�i� _4_vo47. 491E 8. ❑ 5.VISUAL PIPE MONITORING. FREQUENCY: 0 a.DAILY ❑ b.WEEKLY ❑ c.MIN.MONTHLY&EACH TIME SYSTEM OPERATED. 490.49. ..--__�Allowed for,maumnoflnburied em?r8?wY _aaiwNelpipingpnly PExsc_giszsts@7�3 ...___...._._ BI^ 490.50. ❑ 6_SUCTION PIPING MEETS EXEMPTION CRITERIA.1x3 CCR§aa6(sl(all ❑ 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.713 CONNECTED TO THE TANK SYSTEM. -ago-s2. ❑ 99.OTHER(Specify) --- -- --- 490,s3. UPCF UST-D(12!2007)-1/4 wwmvnidoea,org