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1 UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN-(Page I of 2) TYPE OF ACTION ❑ 1.NEW PLAN 2.CHANGE OF INFORMATION 1 PLAN TYPE 1.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. )0'2 (Check one item only) ❑ 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S)- I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) I I I - I I I 1 -1 1 1 1 1 1 11 BUSINESS NAME(Same as FACILITY NAME) ILLO STArr WM 4& SVPqS; 3. BUSINESS SITE ADDRESS ` `LOL W AIf 103' CITY 104. 11.EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE Testing,preventive maintenance,and calibration of monitoring.equipment(e.g.,sensors,probes,line leak detectors,etc.)must!?e performed at the frequency specified by the equipment manufacturers'instructions,or annually,whichever is more frequent,and that such work must be perfo`rined by qualified personnel. 23 CCR§2632,2634,2638,2641 4%-3a MONITORING EQUIPMENT IS SERVICED Dff 1.ANNUALLY ❑ 99.OTHER(Specify): 49.36 1I1.MONITORING LOCATIONS ❑1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. ja 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 2634)4,)1" IV.TANK MONITORINGIS PERFORMED USING THE FOLLOWING METHOD(S): 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT 41N1-5 VAULT(S)WITH AUDIBLE AND VISUAL ALARMS. (23 CCR§2632,2634) SECONDARY CONTAINMENT IS: ® a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED ❑d.UNDER VACUUM 49,K PANEL MANUFACTURER: ""Pm- o[ 490-7. MODEL S'O 49)'8 LEAK SENSOR MANUFACTURER: fy_ 490-9. 1MODEL#(S): 7 4% LfStO - 3Z 490-10 ❑ 2.AUTOMATIC TANK GAUGINV(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).(23 CCR§2643) 490-11 PANEL MANUFACTURER: \ 49(1-12. MODEL#: 41A)-13 IN-TANK PROBE MANUFACTURER: _ 490.14. MODEL#(S): 490.15 LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAFLY/NIGHTLY ❑ c.WEEKLY 4x)-16 ❑ d.MONTHLY ❑ e.OTHER(Specify): 41x)-17 PROGRAMMED TESTS: C] a.0.1 g.p.h. [Ib.0.2 g.p.h. ❑ c.OTHER(Specify): 490•19 4'x>-19 ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 4'x''20 ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§2645). TESTING PERIOD: Ela.36 HOURS El b.60 HOURS 4)-11 49.22 ❑ 5.TANK INTEGRITY TESTING(23 CCR§2643.1): . 490.23 TEST FREQUENCY: ❑ a.ANNUALLY 4''°'24 Q ❑ b.BIENNIALLY ❑ c.OTHER(Specify): 490-25 ❑99.OTHER (Specify): 490.26 490.27 V.PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) 1.CONTINUOUS MONITORING OF PIPE/PH'ING SUMPS)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 41x)-28 VISUAL ALARMS. (23 CCR§2636) SECONDARY CONTAINMENT IS:Ka.DRY ❑b.LIQUID FILLED ❑c.PRESSURIZED ❑d.UNDER VACUUM 4%)-29 PANEL MANUFACTURER: 1 IE2!112____¢-W'T_ __ 49.3° MODEL#: Lt, 1,5C) 4`X)-31 490 32 LEAK SENSOR MANUFACTURER: VG GD0'R .LOO'` MODEL#(S):'moi j Q. -323 41M.33 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. LV a.YES ❑b.NO 490-34 FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. tga.YES ❑b.NO 41X)-35 ❑ 2.MECHANICAL LINE LEAK DETECTOR(MLLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS AND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK IS DETECTED 23 CCR 2636 _ _ 490-36 MLLD MANUFACTURER(S): 490-37 MODEL#(S): 4x)-38 ® 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS (23 CCR§2636) 49._39 ELLD MANUFACTURER(S) %f t?'2 KL RooT '(l lg y1,I( i t O Sg�L _ MODEL#(S): Pc.�.Q g1'f�1C� � PROGRAMMED IN LINE LEAK TEST: ❑ 1.MINIMUM MONTHLY 0.2 g.p.h. ❑ 2.MINIMUM ANNUAL 0.1 g.p.h. 4%41- ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. a.YES ❑b.NO 4x)")3 ELLD FAILURE/DISC6NNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ®a.YES ❑b.NO 49044 ❑ 4.PIPE INTEGRITY TESTING 4x)45 TEST FREQUENCY ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(Specify) 4x)..25,49("7 ❑ 5.VISUAL PIPE MONITORING. 4%).48 FREQUENCY ❑ a.DAILY ❑ b.WEEKLY ❑C.MIN.MONTHLY&EACH TIME SYSTEM OPERATED* 4•x49 •.Ulmed for m iioring of unburied ewer m generator fuelpiping- onlc HSC 2528.5(6X3) ❑ 6.SUCTION PIPING MEETS 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 4 x)-51 4x)-52 99.OTHER(Specify) 49.53 UPCF UST-D(12/2007)1/4