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IFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN- Pae 1 of 2 TYPE OF ACTIONk�,r 1.NEW PLAN ❑ 2.CHANGE OF INFORMATION 190'1 PLAN TYPE Ia1 1.MONITORING IS IDENTICAL FOR ALL UST.,AT THIS FACILITY_ k k one item onl ❑ 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S,) I. FACILITY INFORMATION FACILITY ID#(Agency Use Olt/3) BUSINESS NAME(Same as FACILITY NAME) /�1 1 L Un 1 7 ) ' BUSINESS SITE ADDRESS -)a 5-775 S . cv� 103 CLTY r0. 104. 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,and that such work must be performed by qualified personnel. (23 CCR$2632.2634,2638,2641 490-3a MONITORING EQUIPMENT IS SERVICED 1.ANNUALLY ❑ 99.OTHER(Specify): 490-31; III.MONITORING LOCATIONS 1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN.X2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 2634)49o-4 IV.TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT 490.5 VAULT(S)WITH AUDIBLE AND VISUAL ALARMS. (23 CCR§2632,2634) SECONDARY CONTAINMENT IS: a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED_❑d-UNDER VACUUM 490-6 ------- --- ---- -- -- - -- - ------------•--------- PANEL MANUFACTURER: jL� 4900-. _MODEL#: _T-L_5-3!$a 490-8 LEAK SENSOR MANUFACTURER 490-9 MODEL#(S): - -(�- -----ago-10 ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).(23 CCR§2643) 490-11 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 ---...-....-- --0 d.MONTHLY ❑ e.OTHER(Specify): 490-17 PROGRAMMED TESTS: ❑ a.0.1 g.p.h. ❑ b.0.2 h. El c.OTHER(Speci4WIR ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§2645). TESTING PERIOD: ❑ a.36 HOURS7 b.60 HOURS 490'21 ❑ 5.TANK INTEGRITI'TESTING(23 CCR§2643.1): 490-2249x23 TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): 490-24 490-25 ❑99.OTHER (Specify): 490.26 490-27 V.PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) CR 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 49n-29 ISUAL ALARMS. (23 CCR§2636) -SECONDARY CONTAINMENT IS:f9a.DRY ❑b.LIQUID FILLED ❑c.PRESSURIZED ❑d.UNDER VACUUM-- 490-'-9 PANEL MANUFACTURER: \/ ---------- ---------------- � e r (op-{' 490-30 ! MODEL#: 3 " - 490.31 0 3�- - - 'ra�- - LEAK SENSOR MANUFACTURER: V eed er rcp49 t _ MODEL#(S)` 490-33 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. a. - � a.YESS ❑b.NO 490'34 FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. D§a.YES ❑b.NO 490-35 ❑ 2.MECHANICAL LINE LEAK DETECTOR(AILED)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS AND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK IS DETECTED(23 CCR 42636) 490-36 MLLD MANUFACTURER(S): - - --- - 490-37 MODEL#(S): ------- 490-30- 1. 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g p.6.LEAK TESTS (23 CCR§2636) 490.38 --- --------------------------_---- LLDMANUFACTURER(S) of r(�p 49040. i 49011 MODEL#(S): ��{B`•[----------------------- PROGRAMMED IN LINE LEAK TEST: -- --�---------.-- - ----------------- ❑ 1.MINIMUM MONTHLY 0-2 g.p.h. ❑ 2.MINIMUM ANNUAL 0.1 g.p.h. 490-+'- ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. Aa.YES ❑b.NO 49043 ELLD FAILUREIDISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. �(a.YES ❑b.NO 49044 ❑ 4.PIPE INTEGRITY TESTING 49045 TEST FREQUENCY ❑ a,ANNUALLY ❑ b-EVERY 3 YEARS ❑ c.OTHER(S eci ❑ 5.VISUAL PIPE MONITORING. 490 1649047 FREQUENCY A90-48 Q a.DAILY ❑ b.WEEKLY ❑c.MIN.MONTHLY&EACH TIME SYSTEM OPERATED' 49o-a9 •Allowed for monimrin of unburied erator a,et -Ing Duly tISC 25281.5 ) I ❑ 6.SUCTION PIPING MEETS EXEMYrION CRITERIA 123 CCR§2636(a)(3)J. 490-50 ❑ 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM 490-51 r] 99,OTHER(Specify) 490-52 490-53 UPCFUST-D(12/2007)1/4