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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN-(Page 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. 4900-' (Check one item only) ❑ 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 or DBA) 3. Std cls n f)IP e G 0 0 BUSINESS SITE ADDRESS 103CITY 104 VL h l- Sfidcl�l cm QVJMN ENT TE$TMG Al D PREVENTIVE MAINTENANCE Testing,preventive maintenance,and calibration of monitoring equipment(e.g.,sensors,probes,line leak detectors,ctc.)must be performed at the frequency specified b the ui mrnt manufacttuers'instructions,or annually,whichever is more frequent Such work must be performed qualified personnel.ID CCR¢2632,2634,263x,2641)_ MONITORING EQUIPMENT IS SERVICED 1.ANNUALLY E] 99.OTHER S 1 490-3a ,:. lYIONI`I'ORING LOCATIONS ❑ 1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN 2 SITE PLOT PLANIMAP PREVIOUSLY SUBMITTED [23 CCR f2632.2634, 4904. JV.:i TANI{MONITQRING:IS ERFORMFD USING THE FOLLOWING wffiO (S) hQ Q`kaYl 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) 490-s WITH AUDIBLE AND VISUAL ALARMS.(23 CCR§2632,26341 SECONDARY CONTAINMENT IS: ® a.DRY [Ib.LIQUID FILLED ❑ c.PRESSURIZED El d UNDER VACUUM 490.6. T PANEL MANUFACTURER: L A 0,0 n 49x3. MODEL#: J S' I COO �-P 4904. LEAK SENSOR MANUFACTURER. Z n CO 4W9. MODEL#(S): F. V I V 490-10. ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM °90-1 USED TO MONITOR SINGLE WALL TANK(S).123 CCR;26431 1. PANEL MANUFACTURER 490-12. MODEL#. 490-13. IN-TANK PROBE MANUFACTURER: 490-14. MODEL#(S): 490.15. LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY 490-16. El d.MONTHLY [Ie.OTHER490--17. (Specify): 490-10-. PROGRAMMED TESTS: ❑ a.0.1 g.p.h. ❑ b.0.2 g.p.h. ❑ c.OTHER(Specify): 490-19. ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION[23 CCR 42646.11 490-20. ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)[23 CCR 426451 TESTING PERIOD: ❑ a.36 HOURS [Ib.60 HOURS_ 490922. ® 5.TANK INTEGRITY TESTING PER[23 CCR 02643.11 490-23. _ TEST FREQUENCY: a.ANNUALLY_ ❑ b.BIENNIALLY ❑ c.OTHER(Specify): _ 4904.25 z0-. 490-26. 99.017HER($ i ): Tfi,3111tiLi -M Q C d 490-27. CheaEa ;;,! � It� TOiG�`YS PRFRID Us ?0 jar a ITe yj tr :. , 14 1.CONTINUOUS MONITORING OF PIPEIPIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE&VISUAL ALARMS. 490-21. [23 CCR SECONDARY CONTAINMENT IS: a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED ❑ d.UNDER VACUUM 490-29. 42636] PANEL MANUFACTURER: r n CQ o 490-30 MODEL#: TS'1000 a Q 490-31. LEAK SENSOR MANUFACTURER: r fl C 0 Q °9x32. MODFL#(S) 'TSP q 4S 490-33. PIPING LEAK ALARM TRIGGERS AUTOMATIC PIMP(i.e.,TURBINE)SHUTDOWN. gI a YES ❑ b.NO 490-34. FATLURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. 21 a.YES ❑ b.NO 490-35. 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 CCR426361 _ MLLD MANUFACT rRNRrcr (��p "S�g C f( QsZ 490 37.- MODEL#(S): x I E )� 4900-0-. ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS.123 CCR426361 490-39. ELLD MANUFACTUMANUFACTURER(S): 490.40. MODEL p(S): 490.41. PROGRAMMED IN LINE LEAK TEST: ❑ a.MINIMUM MONTI-LY 0.2 g.p.h. ❑ b.MINIMUM ANNUAL 0.1g P.h. 490-42. ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN ❑ a.YES ❑ b.NO 4903' ELLD FAILUREIDISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. _ _ ❑ a.YES ❑ b.NO 490.44' - 490-45. ® 4.PIPE INTEGRITY TESTING. 49046. TEST FREQUENCY: _ I$ a ANNUALLY [I b.-----EVERY 3 YEARS I] e.OTHER(Specify) _49047_ -- ------ --- �- 49048. ® 5.VISUAL PIPE MONITORING. FREQUENCY: ❑ a.DAILY ❑ b.WEEKLY ® c.MIN.MONTHLY do EACH TIME SYSTEM OPERATEI)` 4"49 •Albwed fa-wton -of vobu_ed wrctxeucY Rmer4tor fucl M�"fi_o�ly oer HSC 4252E 1.5(bH3�__._____ ---- ---- .---..-.^._ 490-50. ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA.123 CCR 42636(,)(3)] ❑ 7,NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM.- 490.51. 490-sz. ❑ 99.OTHER(S ify) 490.53. UPCF UST-D(12!2007)-1/4 www.unidocs.org £TO/9000 XVa EO -TT nH.L 60OZ/60/90