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UPCF UST -D (12/2007) 1/4 UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN - (Pae 1 of 2) TYPE OF ACTION ❑ 1. NEW PLAN ❑ 2. CHANGE OF INFORMATION 490-1 PLAN TYPE ❑ 1. MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. 490-2 (Check one item olily) ❑ 2. THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S). I. FACILITY INFORMATION FACILITY ID # (Agency Use Only) - - 1 BUSINESS NAME (Same as FACILITY NAME) 3. BUSINESS SITE ADDRESS 103. CITY 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)_ ER S eci MONITORING EQUIPMENT IS SERVICED ❑ 1. ANNUALLY [199. OTHfy) (P � 490-3a 490-3b III. MONITORING LOCATIONS ❑ 1. NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. ❑ 2. SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR §2632, 2634)490-4 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 El b. LIQUID FILLED ❑ c. PRESSURIZED E] d. UNDER VACUUM 490 6 PANEL MANUFACTURER: 496-7. MODEL #: 490-8 LEAK SENSOR MANUFACTURER: 490-9. MODEL #(S): 490-10 ❑ 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 ❑ d. MONTHLY ❑ e. OTHER (Specify): 490-17 PROGRAMMED TESTS: ❑ a. 0.1 h. ❑ b. 0.2 h. ❑ c. OTHER g•P� g•P• (Specify): 490-18 490-19 ❑ 3. MONTHLY STATISTICAL INVENTORY RECONCILIATION (23 CCR §2646.1): 490-20 El 4. WEEKLY MANUAL TANK GAUGING (MTG) (23 CCR §2645). TESTING PERIOD: ❑ a. 36 HOURS [Ib. 60 HOURS 490-21 90 zz ❑ 5. TANK INTEGRITY TESTING (23 CCR §2643.1): 490-23 TEST FREQUENCY: Ela. ANNUALLY Elb. BIENNIALLY [:1c. OTHERS eci (P fY)� 490-24 490-25 El99.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/ PIPING SUMP(S) AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 490-28 VISUAL ALARMS. (23 CCR §2636) SECONDARY CONTAINMENT IS: ❑a. DRY ❑b. LIQUID FILLED ❑c. PRESSURIZED ❑d. UNDER VACUUM 490-29 PANEL MANUFACTURER: ago-3o MODEL #: 0-90-31 LEAK SENSOR MANUFACTURER: 490-32 1 MODEL #(S): 490-33 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP (i.e., TURBINE) SHUTDOWN. ❑ a. YES ❑ b. NO 490-34 FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a. YES ❑ b. NO 490-35 ❑ 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): 490-38 ❑ 3. ELECTRONIC LINE LEAK DETECTOR (ELLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS (23 CCR §2636) 490-39 ELLD MANUFACTURER(S) 49"17 MODEL #(S): 49041 PROGRAMMED IN LINE LEAK TEST: ❑ 1. MINIMUM MONTHLY 0.2g.P. h. El2. MINIMUM ANNUAL 0.1 g.p.h. 490-42 ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a. YES ❑ b. NO 490-43 ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a. YES ❑ b. NO 49044 ❑ 4. PIPE INTEGRITY TESTING 49045 TEST FREQUENCY ❑ a. ANNUALLY ❑ b. EVERY 3 YEARS ❑ c. OTHER(Specify) 49046 49047 ❑ S. VISUAL PIPE MONITORING. 49048 FREQUENCY ❑ a. DAILY ❑ b. WEEKLY ❑ C. MIN. MONTHLY & EACH TIME SYSTEM OPERATED' 49049 " Allowed for monitoring of unburied emergency enerator fuel piping only per HSC 25281.5 3 ❑ 6. SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR §2636(a)(3)]. 490-50 ❑ 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) 49°-52 490-53 UPCF UST -D (12/2007) 1/4