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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN - (Page i of 2) TYPE OF ACTION ❑ 1- NEW PLAN 2. CHANGE OF INFORMATION 490-1 PLAN TYPE K 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)- L FACILITY INFORMATION FACILITY ID # (Agency Use Only) Ti 1-1_ 1 BUSINESS NAME (Same as FACILITY NAME)Ctjea 6 14 7-- 3. BUSINESS SITE ADDRESS 0' A 103.CITY _5 r>G/�TOAlq_��'e04 IL EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE Testing, preventive maintenance, and calibration of monitoring equipment (e.g., sensors, probes, line leak deter -tris, rcry specified by the equipment manuhwWrers' , or annually, whichever is more frequent, and that such work m el. 23 CCR §263Z 2634 2638 2641 MONITORING EQUIPMENT IS SERVICED I. ANNUALLY [j 99. 99.OTHER S eci 2 U Iv 490-36 490-3b III. MONITORING LOCATIONS cl 1. NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. 2. SITE PLOT PLAN/MAP PREVI6NVftNMVtb. t0aft632, 2634 so -a PMMITIRBVIGES IV. TANK MONITORING IS PERFORMED USING THE FOLLOWIN 1. CONTINUOUS ELECTRONIC TANK MONITORING OF 490.5 VAULT(S) WITH AUDIBLE AND VISUAL ALARMS (23 CCR §2632,2634) SECONDARY CONTAINMENT' IS: Era. DRY b. LIQUID FIL1.ID ❑ c- PRESSURIZED [3d. UNDER VACUUM 4` 0-6 PANEL MANUFACTURER: e e 0 7 I MODEL # O a90 -s 49D-9. LEAK SENSOR MANUFACTURER: B OOtI MODEL #(S): PO- ❑ 2. AUTOMATIC TANK GAUGING (ATG) SYSTEM USED TO MONITOR SINGLE WALL TANKin (23 CCR §2643) 49011 PANEL MANUFACTURER: 490-12 MODEL #: 490-13 IN -TANK PROBE MANUFACTURER- 490-14. MODEL #(S):� _ _ 490-15 - LEAK TEST FREQUENCY: ❑ a. CONTINUOUS - ❑ b. DAILY/NIGHTLY ❑ c. WEEKLY 490-16 ❑ d. MONTHLY ❑ e. OTHER (Specify): - ---- 490-17 PROGRAMMED TESTS: ❑ a. 0.1 g p.h. b- 02 g p.h. ❑ c. OTTER (Specify): 4990--19 ❑ 3. MONTHLY STATISTICAL INVENTORY RECONCILIATIGN (23 CCR 490.20 f-14. WEEKLY MANUAL TANK GAUGING (MTG) (23 CCR §2645 TESTING PERIOD: ❑ a- 36 HOURS ❑ b- 60 HOURS 490-21 490_?2 5. TANK INTEGRITY TESTING (23 CCR §2643.1): 490.23 TEST FREQUENCY:,,& ANNUALLY Elb-BIENNIALLY El c. OTHER (Specify): y�25 490-26 ❑ 99. OTHER (Specify): 490.27 V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply) �I 1. CONTINUOUS MONITORING OF PIPE! P1P1<1Vf2 cr rennrc% ♦ wtn n-rrrco ec-wtn • ov r-wrr • iwrwrcwrr vrvrr: •smtr.. o w D 400-28 VISUAL ALARMS (23 CCR §2636) 490 z9 SECONDARY CONTAINMENT IS: DRY 19b. LIQUID FILLED [1c. PRESSURIZED [1d. UNDER VACUUM PANEL MANUFACTURER: eP 'i - 491x0 i MODEL #: ,L 3 s-0 490-31 ♦... t ✓ Il 490-32 ,.....-. .,.«. `7Q / # -P P 'i r. LEAN: Si:`t iJvn ivwi�urri� i vi u.. r C ' rr ' \.. __ %_". - - - - 490-33 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP (Le., TURBINE) SHUTDOWN. 14 a. YES ❑ b. NO 490-35 GRING SYSTEM TRIGGERS AUTOMATIC PUMP SHU0WN. X a. YES ❑ b. NO FAILURE/DISCONNECTION OF The ,401.4TTTD3 490-35 �. "' • " ..• - • - •----: - - •-- --•- .-- �. '-� •= -' ` -M �•'T �'FI-`TR-I � OR SHUTS OFF 2. MECHANICAL LINE LEAK DETECT .,,...�.�.,. ��rr V PRODUCT FLOW WHEN A LLAK IS ax. i Lu s L"A$ (:i xv 490-36 490 37 MODEL #(S): MLLD MANUFACTURER(S): ReJ Q.GKe 490-34 ❑ 3. ELECTRONIC LINE LEAK DETECTOR (ELLD) THAT ROUTINELY PERFORMS 3.0 g,p.h. LEAK TESTS (23 CCR §2636) 490-39 ELLD MANUFA S 49D•40. MODEL #(S): 49041 PROGRAMMED IN LINE LEAK TEST: ❑ 1. MINIMUM MONTHLY 02 g p.h. ❑ 2. MINIMUM ANNUAL 0.1 g pA M 490.42 ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. * a. YES [Ib. NO C 490'43 ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. % a. YES ❑ b. NO 490-44 4. PIPE IN TEGRITi' TEv'TING 490.45 TEST FREQUENCY W a. ANNUALLY El b. EVERY 3 YEARS ❑ c_ OTHER S 490-464 -4 5. VISUAL PIPE MONITORING. 49048 FREQUENCY A a. DAILY ❑ b. WEEKLY ❑ c_ MIN. MONTHLY & EACH TIME SYSTEM OPERATED* 490-49 • Allowed for momtoj%F. of unburied em env gmmwr fuel piping mly per HSC §25281.5(b)(3) ❑ 6. SUCTION PIPING MEET'S EXEMPTION CRITERIA 123 CCR §2636(a)(3)1. 490-50 7. NO REGULATED PIPING PER HEALTH AND SAFETY CODE, DIVISION 20, CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM 490-51 490-52 ❑ 99. OTHER (Specify) 490-53 UPCF UST -D (1212007)1/4