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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN- Pae 1 of 2 TYPE OF ACTION ❑1.NEW PLAN ❑ 2.CHANGE OF INFORMATION j `1 ) 490-1 PLAN TYPE 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(,,;) I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) I BUSINESS NAME(Same as FACILITY NAME) .� b /,1 �.V CAS G 3 BUSINESS SITE ADDRESS (j' 41 f , `r R/)' 103 CITY µ u II.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 EQUIPMENT IS SERVICED I.ANNUALLY ❑ 99.OTHER490-3' MONITORING E Q (Specify): 490-3b III.MONITORING LOCATIONS ❑1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN.k2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 2634)49o-4 IV.TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): I.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: - - 411. MODEL#: 490.8 LEAK SENSOR MANUFACTURER: 4901. 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.OTHER49018 g•P• g�P• (Specify): 490-19 ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 490.2° ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§2645). TESTING PERIOD: ❑ a.36 HOURS [Ib.60 HOURS 4990--22 ❑ 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 490-23 TEST FREQUENCY: [I a.ANNUALLY [Ib.BIENNIALLY [j c.OTHER(Specify): 4990-zs ❑99.OTHER (Specify): 90 4 0 -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 [;UAL ALARMS. (23 CCR§2636) SECONDARY CONTAINMENT IS:%#.DRY ❑b.LIQUID FILLED [3c.PRESSURIZED ❑d.UNDER VACUUM 490-29 ----------- PANEL MANUFACTURER: -� 490-30 MODEL#: - 'S 490-31 LEAK SENSOR MANUFACTURER: N0e,�ra90-3z MODEL#(S): - 490-33 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e,TURBINE)SHUTDOWN. �a.YES ❑b.NO 490-34 FAILUREIDISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. Xa.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 263 - -__-- 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§2630 490-39 -- ------------------ - -- ELLD MANUFACTURER(S) e" r00+ -- 490-40.MODEL#(S): -_- - 49041 PROGRAMMED IN LINE LEAK TEST: ❑ 1.MINIMUM MONTHLY 0.2 g.p.h. ❑ 2.MINIMUM ANNUAL 0.1 g.p.h. 490.42 ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. a.YES ❑b.NO 49043 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.OTHERS 1 4904649047 ❑ 5.VISUAL PIPE MONITORING. 490-48 FREQUENCY ❑ a.DAILY ❑ b.WEEKLY ❑C.MIN.MONTHLY&EACH TIME SYSTEM OPERATED' 49049 •Allowed for monitoring of unburied emerigency gmemtor fuel piping only per HSC 2528I.5 6 3 ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA[23 CCR§2636(x)(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 52 1:199.OTHER(Specify) 490 53 UPCF UST-D(12/2007)1/4