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�A -� UNIFIED PROGRAM CONSOLIDATED FORM ' UNDERGROUND STORAGE TANK MONITORING PLAN- Page 1 of 2) TYPE OF ACTION 3 1 1.NEW PLAN IN 2.CHANGE OF INFORMATION 49 1 PLAN TYPE [ I.MONITORING IS IDENTICAL FOR ALL LISTS AT THIS FACILITY. 490.2 (Check one item ord ) ® 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S)- TY $� L FACILITY INFORMATION FACILIID#(Agency Use Only, - - 1 BUSINESS NAME(Same as FACILITY NAME) SCh R C:J E�M M 3. BUSINESS S[TE ADDRESS 1'1�5s S ( l03 CITY tw HwAy S� STcG\�"C� IL EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE Testing,preventive maintenalrce,and calibration of monimfing equipment(ag,sensors,Probes,line Teak detectors,etc.)muri be performed at 01e frequency specified by the equipment m,,utachm,,,,instructions,or annually,whichever is more frequcnS and that such work must be rformed b 23 CCR 2632 2634 2638 2641 IN y qualified personnel. MONITORING EQUIPMENT IS SERVICED ® 1.ANNUALLY ❑ 99.OTHER(S 69'34 P°e ') III.MONITORING LOCATIONS 4WM 2fi34 L 904 NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN, 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, IV.TANK MONITORING IS PERFORMED USING THE FOLLOWING=THOD(S): 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACES)OR SEARY CONTAINMENT a9's VAULT(S)WITH AUDIBLE AND VISUAL ALARMS, (23 CCR§2632,2634) SECONDARY CONTAINMENT IS: ® a DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED ❑d.UNDER VACUUM 490.& PANEL MANUFACTURER V E R o GiLIi RCs 49'2. I MODEL#: -v 490-9 LEAK SENSOR MANUFACTURER MODEL#(S): 490.10 1U 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGI E&ALL TANK(S) (23 CCR§2643) PANEL MANUFACTURER -{4, a90.1z. 490.11 MODEL#: 490.13 IN-TANK PROBE MANUFACTURER 414. MODEL#(S): 490.15 LEAK TEST FREQUENCY: ❑ &CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY ^9ai6 L---___ _- ❑ d MONTHLY _- -_ ❑ e.OTHER(S e�cify): 4WI7 PROGRAMMED TESTS: ❑ a.0.1 g.p.h. ❑ b.02 g.p.h. ❑ C.OTHER(Specifyg ---_-_."--"wala ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 49�0 ❑ 4.WEEKLY MANUAL TANK GAUGING(MIG)(23 CCR§2645). TESTING PERIOD: ❑ a 36 HOURS ❑ b.60 HOURS 490.21 i.TANK INTEGRITY TESTING(13 CCR§2643.1): 490.23 TEST FREQUENCY: ® a ANNUALLY 4Wn ❑ b.BIENNIALLY ❑ c.OTHER(Specify): 490-24 490.31 ❑99 OTHER (Specify): 490.26 V.PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) 490.27 I.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 490.2a VISUAL ALARMS (23 CCR§2636) SECONDARY CONTAINMENT IS:®%DRY ❑b LIQUID FILLED ❑c PRESSURIZED ❑d UNDER VACUUM 49029 PANEL MANUFACTURER V nE O Ru 490.30 iMODEL#: - 49'31 LEAK SENSOR MANUFACIURERVE� nfZ tZ�] 'C &90.32 - U MODEL#(S) '3 L 3 4WI3 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(I.e.,TURBINE)SHUTDONN. ®a YES 49'33 FAILURE/DLSCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ®a YES ❑b.NO 90.35 2.MECHANICAL LINE LEAK DETECTOR(11HLD)THAT ROUTINELY PERFORMS 3.0 g.pJL LEAK TESTS AND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK IS DETECTED(23 CCR 62636) MLLD MANUFACTURER(S). 49036 &90.37 MODEL#(S): 490.3e L SCI 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.L LEAK TESTS (23 CCR 62636) ELLD MANUFACTURERS) I I�,r) 05 1040. i MODEL#(S) J,6 ;oAc o 49041 PROGRAMMED IN LINE LEAK TEST. ❑ L MINIMUM MONTHLY 0.2 g.p.h. ❑ 2.'INIMUM ANNUAL 0.1P.h4904- ELLD D1:TECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. 8. . 443 ELLD FAILURODISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN_ ®°'YES ❑b.NO 90. 55 a YES ❑b.NO 4% 4.PIPE INTEGRITY TESTING 490.4t TEST FRE UENCY a ANNUALLY b.EVERY YEARS c.OTHER(Specify) 5.VISUAL EEO 49646490.¢7 FREQUENCY ❑ a.DAILY ❑ b.WEEKLY ❑c.MIN.MONTHLY&EACH TO45ESYSTEM 49o.re Nbwd@rmm�wia of mibumd fuel 315C 352x1. 3 OPERA7ID� 490.49 ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA[23 CCR§2636(x)(3)). I.NO REGULATED PIPING PES90'f0 49'51 D ' 0,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM ❑ 99.OTHER S ( PTY) y 490-32 490.51 MAR 16 2017 UPCF UST-D(12/2007)114 _ ENVIRONMENTAL HEALTH DEPARTMENT