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UNIFIED PROGRAM CONSOLIDATED FORIVA !-} UNDERGROUND STORAGE TANK u MONITORING PLAN-(Pae 1 of 2) TYPE OF ACTION ❑1.NEW PLAN I] 2.CHANGE OF INFORMATION 2008 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(;)- ENVIRONMENT HEA LTE I. FACILITY INMRAIATION FACILITY ID#(Agency Use Only) I I I - - BUSINESS NAME(Same as FACILITY NAME) Lodi Memorial Hospital 3 BUSINESS SITE ADDRESS 975 S. Fairmont Ave. 103 CITY Lodi 104. H.EQUIEPMENT 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 MONITORING EQUIPMENT IS SERVICED ® 1.ANNUALLY ❑ 99.OTHER(Specify): 4�3b III.MONITORING LOCATIONS ❑L NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN.XX 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 2634)90.4 IV.TANK MONITORING IS PERFORACM USINGXM FO WINGMETHOD(S): MC 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 [Ib.LIQUID FILLED ❑ c.PRESSURIZED ®d.UNDER VACUUM 490-6 PANEL MANUFACTURER: 490 7 MODEL#: 970 49041 LEAK SENSOR MANUFACTURER: EBW 490-9' MODEL#(S): LS -3A 490-10 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(Sl.(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): 490-17 490.18 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§2646.1): 490.20 ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§2645). TESTING PERIOD: ❑ a.36 HOURS [:1b.60 HOURS 44 22 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 490.23 490-24 TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): 490.25 490.26 ❑99.OTHER (Specify): 490-27 V.PIPE MON17`01UNG IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) I.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 490.28 VISUAL ALARMS. (23 CCR§2636) SECONDARY CONTAINMENT IS:Ela.DRY []b.LIQUID FILLED ❑c.PRESSURIZED [3d.UNDER VACUUM 490 29 PANEL MANUFACTURER: EBW 490-3o MODEL#: 9 7 Q 490-31 LEAK SENSOR MANUFACTURER: EBW 493' MODEL#(S): LS-3A 490-33 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. ❑a.YES ❑b.NO 49D-34 FAILUREIDISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑&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 26 490-36 MLLD MANUFACTURER(S): 417 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) 49040. 1 MODEL#(S): 490,41 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 490.43 ELLD FAILURE/DISCONNECPION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 49044 4.PIPE INTEGRITY TESTING 49o-4s TEST FRE UENCY 0 a.ANNUALLY IM b.EVERY 3 YEARS c.OTHERS i 490-4649047 5.VISUAL PIPE MONITORING. 490648 FREQUENCY ❑ a.DAILY ❑ b.WEEKLY ❑C.MIN.MONTHLY&EACH TIME SYSTEM OPERATED* 490.49 "Allowed for nwnitoring of unburied emergency lwwWw fuel piping ody per HSC L25281.5(b)(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 49°-52 ❑ 99.®TREK(Specify) 0." UPCF UST-D(12/2007)1/4