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IFIED PROGRAM CONSOLIDATEDM UNDERGROUND STORAGE TANK MONITORING PLAN - (Page I of 2) JUN 2 7 2013 TYPE OF ACTION ❑ 1.NEW PLAN ❑ 2.CHANGE OF INFORMATION X40-i PLAN TYPE ❑ 1.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. ENVIReNMENTAL°-2 (Check one item only) El2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): HEALTH DEPARTMENT I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) BUSINESS NAME(Same as Facility Name or DBA) 'rR A BUSINESS SITE ADDRESS 103. CIT104 `7o L• VPz - '1-1AR-rw L)r14 rz R K" V R MW I YKa 6 k I-VAI - H. 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 263 2634,2638 2641 EQUIPMENT IS SERVICED � 1.ANNUALLY ❑ 99.OTHER490-3a. MONITORING E Q (Specify): 490-3b. III. MONITORING LOCATIONS ❑ 1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN R 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED [23 CCR§2632,2634] 490-4, IV. TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) (deck all ❑ 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) 490-5. WITH AUDIBLE AND VISUAL ALARMS.[23 CCR§2632,26341 SECONDARY CONTAINMENT IS: "_a.DRY T❑ b.LIQUID FILLED ❑ c.PRESSURIZED El d.UNDER VACUUM 490-6. PANEL MANUFACTURER: ��F_T)5R I�.DOT 490-7. MODEL#: TLS v 490-8. LEAK SENSOR MANUFACTURER: 490-9. MODEL#(S : " 7.ago-lo 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).[23 CCR§26431 r 490-11 PANEL MANUFACTURER: 490-12. MODEL#: 49°-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 h. Rr b.0.2 h. ❑ c.OTHERS ci 490-18. _ ••--•----......-............................................-._. _.__..-.g.p.h. g.p.h. fy)._ 490-19. .. .__..............___ ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION[23 CCR§2646.11 _ -�................ ___..__ �-__.............. --_ .......... .__......._.. _.. ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)[23 CCR§26451 TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS49 _ 0-22. 5.TANK INTEGRITY TESTING PER[23 CCR§2643.11 490-23. TEST FREQUENCY: X a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER490-24. (Specify): 490-2s. ❑ 99.OTHER(Specify): 490-26. 490-27. V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) Check a" 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE&VISUAL ALARMS. 490-28. [23§16363 SECONDARY CONTAINMENT IS: X a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED 1 ❑ d.UNDER VACUUM 490-29. V PANEL MANUFACTURER: E E D F R R D D'T 490-30. MODEL#: T L S' ?s-0 490-31. LEAK SENSOR MANUFACTURER: 490-32. MODEL#(S): " 2_09 490-33. PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. ❑ a.YES U b.NO 49434. FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN._ ❑ a.YES ❑ b.NO 490-35. K _- MECHANICAL LINE LEAK DETECTOR(MLLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS AND RESTRICTS OR SHUTS OFF 490-36. PRODUCT FLOW WHEN A LEAK IS DETECTED.[23 CCR§2636] MLLD MANUFACTURER(S): R�� G Ked" 490-37. MODEL#(S): F x 1,/ 490-38. . _.-....._.......---•--.._.............. 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS.[23 CCR§26361 490-39. ELLD MANUFACTURER(S): 490-40. MODEL#(S): 490.41. PROGRAMMED IN LINE LEAK TEST: a.MINIMUM MONTHLY 0.2 g.p.h. ❑ b.MINIMUM ANNUAL 0.1 g.p.h. 491-42. ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. a.YES ❑ b.NO 49143, ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. a.YES ❑ b.NO 491-44- .... _ .._ ..._.__...._................._-_............... _ _ _ ..._._.._.._ _ .. _.___._........_.. --.....-_-----_...-......._.....__._..........._.._._.....-..-. PIPE INTEGRITY TESTING. 490-45. TEST FREQUENCY: a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(Specify) 490 490-46. 6 .VISUAL PIPE MONITORING. 490-48. FREQUENCY: a.DAILY ❑ b.WEEKLY ❑ c.MIN.MONTHLY&EACH TIME SYSTEM OPERATED* 490-49. .............. _•Allowed for monitoring of unburied emerge q,,&eneratorkq.pjpj9A ons HSC-X25281 SM3�•-_••- ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA.[23 CCR§2636(ax3)1 ago so. __ __ __._........-..___..... __.._ .._.......---....__............................... -- -- ❑ 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM. 490-51. -- _99.OTHER(Specify) 490-52. 490-53.