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IFIED 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. 490-2 (Check one item only) ❑ 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM($) I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) BUSINESS NAME(Same as FACILITY NAME) Yosemite 76 #255417 3 BUSINESS SITE ADDRESS 1700 East Yosemite Avenue t03 CITY Manteca 104, 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) _ -------------- --- - - -------------------------------------------------------------------------------------- --------------------------------------------------------------------------------- MONITORING EQUIPMENT IS SERVICED ® 1.ANNUALLY ❑ 99 OTHER(Specify): 49o-3b III.MONITORING LOCATIONS ® 1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. ❑2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 2634)490-4 IV.TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): ® 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 S: ® a.DRY E] b,LIQUID FILLED ❑ c.PRESSURIZED C] - ---- d.UNDER VACUUM--- 49 0-6 ----------------------------------------------------------I----------------------------------------------------------------------------------------------------------- ---------------------------------------------- -- 490-7, I PANEL MANUFACTURER: Veeder Root 1 MODEL#: TLS-350 490-8 --------------------------4 _9-t------------------- -------------------------------------------------------490--- LEAK SENSOR MANUFACTURER: Veeder Root I MODEL#(s): 794380-420 ❑ 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 ------------------------------------------------------------------------------------------------------------------------------------------ 4--------------------------------------------------------------------------------- IN-TANK PROBE MANUFACTURER: 4990-0-1-- EL#(S): 490-1s ----------------------------------------------------------------------------------------------------------------------------------- -- -- -- -- -----------MOD------------------------------------------------------------------------------ LEAK TEST FREQUENCY: ❑ a.CONTINUOUS [Ib.DAILY/NIGHTLY ❑ c.WEEKLY 490.16 ❑ d.MONTHLY ❑ e.OTHER(Specify): 490-17 -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------18 PROGRAMMED TESTS: ❑ a.0.1 h. ❑ b.0.2 h. ❑ c.OTHERS eci 490-18 g.p. g.p.h. (Specify): 490-11 ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 490-20 F] 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§2645). TESTING PERIOD: Ela.36 HOURS Elb.60 HOURS 410- _410-12 ❑ 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 490-23490-24 90 23 TEST FREQUENCY: Ela.ANNUALLY El b.BIENNIALLY El c.OTHER(Specify):S eci 490 24 490-2s 490-26 ❑99.OTHER (Specify): 490-27 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 VISUAL ALARMS. (23 CCR§2636) SECONDARY CONTAINMENT IS:Na.DRY ❑b.LIQUID FILLED ❑c.PRESSURIZED ❑d.UNDER VACUUM 490-z1 - - - ----------------------------- - - PANEL MANUFACTURER: Veeder Root 490 30 MODEL#: TLS-350 490-31 ------------------------------------------------------------------------------------------------------------------------------------------------I ------------------------------------ - 490-32 LEAK SENSOR MANUFACTURER: Veeder Root 1 MODEL#(S): 794380-208 490-33 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. ®a.YES Elb.NO 4e0-34 FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ®a.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 j2636)------------------------------------------------------------------------------------------------------- 490-36 ------------------- ---- - ------------------------------------------------ - -- - - MLLD MANUFACTURER(S): Va orless 490-37 MODEL#(S): LD2000 490.38 ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS (23 CCR§2636) 490-39 --------- 490-40 -----------------------------------------------------------------------------------------------------------------------------r------------------------------------ --------- ELLD MANUFACTURER(S) ;-MODEL#(S): ------------------------------------------------------------------------------------------------------------------------------------------------- ---------- --42 PROGRAMMED IN LINE LEAK TEST: ❑ 1.MINIMUM MONTHLY 0.2 h. ❑ 2.MINIMUM ANNUAL 0.1 h. 49042 g.p. g.p.h. ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES Elb.NO 490-43 ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES El b.NO 490 44 [] 4.PIPE INTEGRITY TESTING 490-4s TEST FREQUENCY ❑ a.ANNUALLY ® b.EVERY 3 YEARS ❑ c.OTHER(Specify) 490-46 490-47 ❑ 5.VISUAL PIPE MONITORING. 49048 FREQUENCY ❑ a.DAILY ❑ b.WEEKLY ❑c.MIN.MONTHLY&EACH TIME SYSTEM OPERATED* 490-49 •Allowed for monitori ns of unburied emer ency generator fuel pi ping only per HSC§25281.5(6)(3 ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR§2636(a)(3)1. 490-50 ❑ 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM ' 49051 ---- 490 52 � ❑ 99 OTHER(Specify) 490-53 UPCF UST-D(12/2007)