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i I `M UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN -(Pagel of 2} 490.1. TYPE OF ACTION ❑ I.NEW PLAN I,'�.2.CHANGE OF INFORMATION 4x)-2. ---------------- PLAN TYPE ® 1.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. (Check one item arty) 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) 3. BUSINESS NAME(Same as Fa 'kypme or 19 BA) 1 103. CITY c r t w. BUSINESS SIT DD S eel U. EQ, PMENT 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 egtripment manufacturers'instructionsTor annually,whichever 1s,more frequent Suchwork must be performed by qt alitled personnel (z3 cex 4�t3z,z63a 2.38,264 11 _ .... .-- G0-3a 1.ANNUALLY ❑ 99.OTHER(Specify): 490-36. MONITORING EQUIPMENT I5 SERVICED III. MONITORING LOCATIONS 4904 ❑ 1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED I23 CCR§2632,26341 (Check ail IV TANK MONITORING IS PERFORMEED USING THE FOLLOWING METHODS} that a l) AUL"C(S} 4vo-s. 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACES)OR SECONDARY CONTAINMENT V WITH AUDIBLE AND VISUAL ALARMS.I23 CCR§2632,263411 d.UNDER VACUUM SECONDARY CONTAINMENT[S: a.DRY b.LIQUID FILLED ❑ c.PRESSURIZED �-- -=-r �� 490-8 490-7. MODEL#: PANEL MANUFACTURER: aw y 490-10. MODEL#(S) LEAK SENSOR MANUFACTURER: --- 490.0. [] 2 AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL"TAWNKz S .M CCR L#: 39033. PANEL MANUFACTURER: MODEL#: 11-14. 490-15. MODEL#(S): IN-TANK PROBE MANUFACTURER: c.WEEKLY 490-16. LEAK TEST FREQUENCY: F1 a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ avo-1T ❑ d.MONTHLY ❑ e OTHER(Specify): 490-19, ❑ c OTHER(Specify): 4��_t9._ . PROGRAMMED TESTS: -® a O-- .l g p:h b0 2P.❑ g:_ ..h ......... _ ...._.._.._ 490-20. -._ ❑ 3 MONTHLY STATISTICAL INVENTORY RECONCILIATION I23CCR§264611 . 4x12 .-. --- - -- TESTING PERIOD ❑ u 36 HOURS Cl b 60 HOURS aw zz ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)I23 CCRk,26451 - -- - ❑ 5 LANK INTEGRITY TESTING PER 123 CCR J2643,11 490-24. TEST FREQUENCY. 0_a.ANNUALLY [Ib BIENNIALLY ❑ c.OTHER(Specify): 490-26. 490-27, ❑ 99.OTHER(Specify): (Check all V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHODS}, that a 1 - 490-2H. (X 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE&VISUAL ALARMS. 123 CCR SECONDARY CONTAINMENT IS: Ela.DRY ❑ W 490-za b.LIQUID FILLED c.PRESSURIZED d.UNDER VACUUM 490-31 §2636] 4%00. MODEL#: _ PANEL MANUFACTURER: 490-32 490-33- LEAK SENSOR MANUFACTURER: MODEL#(S): . a. E5 b,NO 490-34. PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. avows, ...._._..._._ -..-_..._._ .._..___.._._... _._ 490-36... FAILURE/DISCONNECTION OF THE MONITORING SYSTEM(RIGGERS AUTOMATIC PUMP SHUTDOWN a.YES ❑ b.NO ........_.... 2.MECHANICAL LINE LEAK DETECTOR(MELD)THAT ROUTINELY PERFORMS 3.0 g p.h. LEAK TESTS AND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK41STECTED.fz3 CCR§21,361 - L r J % 3903xaw 3z MODEL#(S) Y440-39 MLLD MANUFACTURER(S):__.__. .._..._--- g.p. ago-3v❑ 3.EI,ECTRON[C LING LEAK DETECELLD)` AT ROUT ELY PERFORMS 3.0 h wLEAK TESTS.Iz3 CCR§26361 MODEL#(S): ELLD MANUFACTURER(S): avo-az. a,MINIMUM MONTHLY 0.2 g.p.h. ❑ b.MINIMUM ANNUAL 0.1 g.p.h. PROGRAMMED IN LINE LEAK TEST: ❑ 4x a.YES ❑ b.NO 9-43, ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. E] 390.44. ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. 490-45. ❑ aYES ❑ bNO ® 4.PIPE INTEGRITY TESTING 490-46. a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(Specify_) TEST FREO0ENCY' ❑ __._.. __ ... 4904x: __-__._ .. -__.._ ... -_ .___= 5 VISUAL PIPE MONITORING. . 490-v9. FREQUENCY. ❑ a.DAILY ❑ b.WEEKLY ❑ e.MIN.MON CEILY&EACH TIME SYSTEM OPERATED *Allowed for monitoring of unbuned emer�gnpy„yenernlor fuel p�P.!"Y:.only per HSC_§252N 1.5(_6)(3)_ ....................... _.....__ _._.._ .. .. 4w-50. ❑ 6 SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR§036(3x3)1 _.._ _.._ _ .__ _. --- - .__ ._.....-...... 4911.52_- ❑ 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE DIVISION 2U CHAPTER 6 7 IS CONNECTED TO THE TANK SYS T EM -__ ❑ 99.OTHER(Specify) UPCF UST-D(12/2007)-1l4 www.unidoes.org A