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UNIFIED PROGRAM CONSOLIDATED FORM ' UNDERGROUND STORAGE TANK MIONTTORING PLAN-(Pee I oft TYPE OF ACTION 011 NEW PLAN 1 2.CHANGE OF INFORMATION 490.1 PLAN TYPE ❑ 1.MONITORING IS IDENTICAL FOR ALL UST,AT THIS FACILITY. (Check one item onl ) Ig 2.2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM( 3- Rn7 FACILITY ID# L FACII4ITY INFORMATION (Agency Use Only) BUSINESS NAME(Same as FACILITY NAME) 2Ct1 C:� e,m Q(n BUSINESS SITE ADDRESS IA, �t 5 S I v,1{� S� 103. CFFY i0.. ST oG�-Co IL EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE Testing,preventive iPil3mll w1111 u and calibration ti monimring equipment(e.g.,sermrs,probes,line leek dettttors,etc.)must be performed at the frequency specified by the equipment manufacturers'instructions,or annually,whichever is more frequent,and Nat such work must be 3 CCR 263 2634 2638,2641 Perfom3W by qualified personnel. MONITORING EQUIPMENT IS SERVICED ® I.ANNUALLY ❑ 99.OTHERS ci 49044 490.36 III.MONITORING LOCATIONS 12631.NEW SITE PLOT PLAN/MgP SUBMITTED WITHTH75 PLAN. 2.SRE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 4 4904 Iv TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): L CONTINUOUS ELECTRONC TANK MONITORING OF ANNULAR(INTERSTITL4,L)SFACE(S)OR SECONDARY CONTAINMENT 090.5 VAULTS)WITH AUDIBLE PND VISUAL ALARMS (23 CCR§2632,2634) SECONDARY COMA WMENT IS: a.DRY ❑ b.LIQUID Fn t Fn ❑ c.PRESSURIZED ❑d.UNDER VACUUM 4906 PANEL MANUFACTURER:V E Rco Cn lys7j +Cs 490'7. I MODEL#: 490. LEAK SENSOR MANUFACTURER:V F, _ ^C' V ° 1 MODEL#S: 4912.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANKfc3 (23 CCR§2643) 490.11 PANEL MANUFACTURER: MODEL#: 49013 IN-TANK PROBE MANUFACTURER: MODEL#(S): 49015 LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY(NIGHTLY9016 ❑ c.WEEKLY 4 e_OTHER(Spec�fyZ:_ 44W7PROGRAMMED TESTS_ ❑ a.0.11 ❑ b.02 gp.h. ❑ c OTHER(S -. -a9u-1c ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1):) 490�19 ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR 62645). TESTING PERIOD: ❑ u 36 HOURS ❑ b.60 HOURS 49°'21 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 49x22 TEST FREQUENCY: ® a ANNUALLY ❑ b.BIENNIALLY490.23 ❑ c.OTHER(Specify).- 49024 ❑99.OTHER (Specify): 49026 49036 V.PIPE MONITORING IS PERFORMED USING THE FOLLOWING METRO S Check all that apply) 490.27 ®I.CONTINUOUS MONITORING OF Pll'E/PIPING SUMPS)PND OTHER SECONDARY CONTAINM"I WITH AUDIBLE AND 49028 VISUAL ALARMS (23 CCR§2636) SECONDARY CONTAINMENT LS:®a.DRY ❑b.LIQUID FILLED ❑c.PRESSURIZED ❑d.UNDER VACUUM 490.29 PANEL MANUFACTURER V r� Ro i.3�T 490')0 i MODEL#: - _'3S L• 490-31 L_ LEAK SENSOR MANUFACTURERV'l En R ��-,--� 49a3x MODEL#(SU 7 3 49x33 Ra.YES PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(1.t.,TURBINE)SHUTDOWN. 49034 FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS ALTFOMATIC PUMP SHUTDOWN. J0.a.YES ❑b.NO ❑b.NO 490.35 2.MECHANICAL LINE LEAK DETECTOR(MELD)THAT ROUTINELY PERFORMS 3.0 gp,b.LEAK TESTS AND RESTRICTS OR SHUTS OFF � PRODUCT FLOW WHEN p LEAK IS DETECTED(23 CCR 62636) MLLD MANUFACTURER(S: 49032 49036 MODEL#(S): 49033 A 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 Ill LEAK TESTS (23 CCR§2636) 490.3y ELLD MANUFACTURER(S) 490'°0. MODEL#(S): lL;G) 49041 . PROGRAMMED INLINE LEAK TEST: ❑ I.MINIMUM MONTHLY 0.2 g.p.h ❑ 2.MINIMUM ANNUAL 0.1 49042 g.P.h. ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. . 0 s YES ❑b.NO 40.13 ELLD FAILUREIDISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN, ®a.YES 49044 4.PIPE INTEGRITY TESTING 49096 ❑b.NO TEST FRE UENCY a.ANNUALLY b.EVERY 3 YEARS C.OTHER(5 eci ) 5.VISUAL PIPE MONITORING. + + 42 FREQUENCY ❑ a.DAILY ❑ b.WEEKLY i9" •nn4«wtorew4; or, AY _ __ ❑c.MIN.MONTHLY @ FACR TLS¢SYSTEM OPERATED• 490.49 ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR§2636(a)(3)J. 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.71S CONNECTED TO THE TANK SYSTEM 49a5o 490.31 ❑ 99.OTHER(Specify) 09062 49653 UPCF UST-D(12/2007)1/4 MAR 16 2017 ENVIRONMENTAL HEALTH