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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUNDSTORAGETANK MONITORING PLAN- (Pae 1 of 2) TYPE OF ACTION 1.NEW PLAN ❑ 2.CHANGE OF INFORMATION 490-1 PLAN TYPE 1.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. 490-2 (Check one item only) 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): 4%-a I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) 1. BUSINESS NAME(Same as Facility Name or�"DBA) 3. N-rb--w GTC• s BUSINESS SITE ADDRESS 103 1 BUSINESS SITE CITY 104. II. 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.Such work must be performed by qualified personnel.[23 CCR§2532,MM,2638,25411 MONITORING EQUIPMENT IS SERVICED 1.ANNUALLY 99.OTHER(Specify): 4�3a 490-3b. III. ONTPORING LOCATIONS ❑ 1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN 2.SITE PLOT PLANIMAP PREVIOUSLY SUBMITTED 123 CCR§2632,25341 490-0. IV. TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) (Check-" that- 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) 49 WITH AUDIBLE AND VISUAL ALARMS.123 CCR§2632,26341 SECONDARY CONTAINMENT IS: ®a.DRY ❑� b.LIQUID FILLED ❑ c.PRESSURIZED ❑ d.UNDER VACUUM 4904. PANEL MANUFACTURER: U pQcfe" 9,z�T 'T Lc, 190-3MODEL#: TLS -1SZ 4�, LEAK SENSOR MANUFACTURER: LreeAe-.✓ Jpz" `f-60 490.9. MODEL#(S): ye20 49040. ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(SL 123 ccR 126431 4W-11. PANEL MANUFACTURER: 490.12. MODEL#: 490-13. IN-TANK PROBE MANUFACTURER: 490.14' MODEL#(S): 49-15. LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY 490-16. ❑ d.MONTHLY ❑ e.OTHER(Specify): 490-13. PROGRAMMED TESTS: ❑ x.0.1 g.p.h. ❑ b.0.2 g.p.h. ❑ c.OTHER(Specify): 490.28. ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION ID CCR§2545.0 490.20 ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)ID CCR§25-51 TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS 4v 21. ❑ S.TANK INTEGRITY TESTING PER 12,3 CCR§2543.21 49-23. TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): 490 2,x24. ❑ 99.OTHERS 49 26, ( Pecify): 490-27. (Chckall V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) that p ly) hota 1 [�p 1.CONTINUOUS MONITORING OF PIPEIPIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE&VISUAL ALARMS. 490-28. §um] SECONDARY CONTAINMENT IS: &DRYS `❑ (jE]b.LIQUID FILLED c.PRESSURIZED d.UNDER VACUUM 49-29. PANEL MANUFACTURER: IPF� F ✓ v'='T- 490.30 MODEL#: TLS 3-S-0 490.31, LEAK SENSOR MANUFACTURER: ' 1 Q 490-31 MODEL#(S): 2 O A 49033. PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e,TURBINE)SHUTDOWN. ❑ a.YES ❑ b.NO 490-34, FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ❑ b.NO 4w-" 2.MECHANICAL LINE LEAK DETECTOR(MLLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS AND RESTRICTS OR SHUTS OFF 490-M PRODUCT FLOW WHEN A LEAK IS DETECTED. DcciR§263-61 f-)'T9V0.38 MLLD MANUFACTURWS): F� �JP,"1 Y6� l�� )mr_k4 490-33. MODEL#(S): .5-r10- M�-D ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS.ID CCR§MMI 490.39. ELLD MANUFACTURER(S): 49040 MODEL#(S): 49041. PROGRAMMED IN LINE LEAK TEST: ❑ a.MINIMUM MONTHLY 0.2 g.p.h. ❑ b.MINIMUM ANNUAL 0.1 g.p.h. 490x2. ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ❑ b.NO 490-43. ELLD FAILUREIDISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. _ ❑ a.YES ❑ b.NO 69044 ❑ 4.PIPE INTEGRITY TESTING. TEST FREQUENCY: ❑ &ANNUALLY ❑ b.EVERY 3 YEARS ❑ e.OTHER(Specify) 49 77 6. ❑ 5.VISUAL PIPE MONITORING, 49048 FREQUENCY: ❑ -DAILY ❑ b.WEEKLY ❑ c.MIN.MONTHLY&EACH TIME SYSTEM OPERATED. 49049. •eWo fam Wi ofmburidemer8mcv8mmorfwlpip..x d HSC 25281.3(M3)-___. ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA.ID CCR§2636(.x3)1 49 50. ❑ 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM. 4195:51, ❑ 99.OTHER(Specify) 49090-s2, UPCF UST-D(12/2007)-1/4 www.unidoes.org Effective 01/17/08