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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN-(Page 1 of 2 TYPE OF ACTION IN 1.NEW PLAN ❑ 2.CHANGE OF INFORMATION 490-1 PLAN TYPE DO 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): I1,AGILITY,INFO tMATTON FACILITY M#(Agency Use Only) 1. BUSINESS NAME(Same as Facility Name or DBA) 3, Std C�'( n fl Q e G b y BUSINESS SITE ADDRESS103. CITY 104. I G L •h vn QUFIV�EN,T TE `ITG A I!iI)PRIIVETVE 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 Nuipinctit manufacturers'instructions or annually,whichever is more fmqueuent Such work must be performed by qualified personnel.[23cCR¢zb32,263.4_263x,26441 MONITORING EpQ�UIPMENT IS SERVICED L ANNUALLY ❑ 99.OTHERS 490-3a •K ( I��')� 490-36. IOOA''JONS ❑ 1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED [23 CCR J7632.26341 4904. r (check all all IVB SIA K M0�1T1� I Lr'�& ERFORIYYEb USING,TflE FOLLOWINGMFT IOD(S) r>,ara 1 AV 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) 490-5 WITH AUDIBLE AND VISUAL ALARMS.[23 cat f2632,2634] SECONDARY CONTAINMENT IS: ® e.DRY [Ib.LIQUID FILLED ❑ c.PRESSURIZED ❑ d-UNDER VACUUM 490-6. PANEL MANUFACTURER Z n co n '90'. MODEL#: T S" I(3(30 �'F' 490-8. LEAK SENSOR MANUFACTURER: -Z11 CO n - 490-9. MODEL#(S): Irl V 490-10. ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).(23 CCR;26431 49011. l 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. 49D-17. ❑ d.MONTHLY ❑ e.OTHER(Specify): PROGRAMMED TESTS: ❑ a 0.1 g.p.h. Elb.0.2 g.p.h. ❑ c.OTHER(Specify): 4904-19.x. ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION[23 CCR¢2646.11 490-20. ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)[23 CCR¢26451 TESTING PERIOD: I--] a.36 HOURS El b.b.60 HOURS 490-22. 90 ' ® 5.TANK INTEGRITY TESTING PER[23 cert 02643.11 490-23. TEST FREQUENCY: a.ANNUALLY [Ib.BIENNIALLY ❑ c.OTHERS 490-24._ 490.25. 99.OTHER S i s 0 h L = q-C d 490.n 26. 1J`�rPI$FE VIO I'TO iG Y$pfd Vts ri'I + xQLt.OVi'IlvG 1V1 'SODM :'ha ap i j 14 1.CONTINUOUS MONITORING OF PIPFIPIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE&VISUAL ALARMS. 490-21. 1'cc' SECONDARY CONTAINMENT IS: IX a.DRY Elb.LIQUID FILLED C1c.PRESSURIZED [71d.UNDER VACUUM 490-29. ¢2636) PANEL MANUFACTURER: _ �r)CO n 490-30 MODEL#: T5'I 00b a+ Q 49o-3 1. LEAK SENSOR MANUFACTURER Z 0 C O Q 49032. MODEL#(S): TSP L4L S 490-33. PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. X a YES ❑ b.NO 490-34. FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ® a_YES ❑ b.NO 49D-31- 2.MECHANICAL LINE LEAK DETECTOR(MLLD)THAT ROUTINELY PERFORMS 3.0 gp.h.LEAK TESTS AND RESTRICTS OR SHUTS OFF 490-36. PRODUCT FLOW WHEN A LEAK IS DETECTED.123 CCR¢26361 490-37. X10 F y 1' 490-38. _ MILD MANUFACTURER(S)' Ij,eD '�'gC K E`C MODEL#(S):E 1 ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 gp.h LEAK TESTS.123 CCR¢26361 490 39. ELLD MANUFACTURER(S): 4900 MODEL#(S): 49041. PROGRAMMED IN LINE LEAK TEST: ❑ a.MINIMUM MONTHLY 0.2 g.p.h. ❑ b.MINIMUM ANNUAL 0.1 g.p.h. 49042. ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN ❑ a.YES ❑ b.NO 49041. ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. _ ❑ a.YES ❑ b.NO '9044- 49045. ® 4.PIPE INTEGRITY TESTING. 49046. TEST FREQUENCY: I@ a ANNUALLY ❑ b.EVERY 3 YEARS_ ❑ c OTHER(Specify) _49047_ 49048. ® 5.VISUAL PIPE MONITORING. FREQUENCY: ❑ a.DAILY ❑ b.WEEKLY ® c.MIN.MONTHLY do EACH TIME SYSTEM OPERATED' 49049. •Aibwed(a rnatiWri of imburic6 cawtRcnry 1{menrer tool oiolog_odv xr HSC 6252E ----'-. 490-50. ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR¢2636(,)(3)1 ❑ 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(12/2007)-114 www.uWdocs.org £10/9000 XVJ EO :TT 11HS 600Z/60/90