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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK ONITORING PLAN- Pae 1 of 2) TYPE OF ACTION ❑1. W PLAN V2.CHANGE OF INFORMATION 490.1 PLAN TYPE V1.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. 490-2 (Check one item only) ❑ 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S)- I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) -1 1 1 1 1 1 1 1 BUSINESS NAME(Same as FACILITY NAME) S f fJ3CJPtQ14 L L- 3 BUSINESS SITE ADDRESS 500 Lorpp" 103. CITY4WXjt 52 104 H 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): 490-3b III.MONITO LOCATIONS ❑1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. OW2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 2634)49o-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 CXR§2632,2634) SECONDARY CONTAINMENT IS:_❑ a.DRY .LIQUID FILLED ❑ c.PRESSURIZED ❑d.UNDER VACUUM 490-6 PANEL MANUFACTURER: - V w -- -490 7 LMODEL#: TD 411 LEAK SENSOR MANUFACTURER: £,jj490-9 MODEL#(S): I-S 490-10 ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANKISI.(23 CCR§2643) 0-90-11 PANEL MANUFACTURER: 490-12 MODEL#: 490-13 IN-TANK PROBE MANUFACTURER: 490-14. MODEL#(S): 49x15 -------------- ----- -------- -------------- - --- LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY 490-16 d.MONTHLY--- - ❑ e.OTHER(Specify): 490-17 --------- --- ----------®------- ----------- - --y�----------------- a90-1s 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 ❑ b.60 HOURS 4490- 22 ❑ 5.TANK INTEGRITY TES G(23 CCR§2643.1): 490-23 490-24 TEST FREQUENCY: Pla.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): 490-25 ❑ 99.OTHER (Specify): 490-26490-27 490-27 V.PIPE MONITORING IS PERFORMED USING THE FOLLOWING NIETHOD(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: a.DRY ❑b.LIQUID FILLED ❑c.PRESSURIZED ❑d.UNDER VACUUM 490-29 PANEL MANUFACTURER: W - - 490-30 : MODEL#: y 49°-31 LEAK SENSOR MANUFACTURER: 196W -- _--0-90-32 MODEL#(S): i 490-33 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. S ❑b.NO 490-34 FAILUREMISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. VeYES ❑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 DETECTED(23 CCR§2636) _ --- --_- 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§2636) 490.39 _ ELLD MANUFACTURER(S) -_-_- _ _- 490 40�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 FAILUREMISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 490-44 ❑ 4.PIPE INTEGRITY TESTING 490.45 TEST FREQUENCY 5111a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(Specify) 490-46 490-47 ❑ S.VISUAL PIPE MONITORING. 490-48 FREQUENCY ❑ a.DAILY ❑ b.WEEKLY ❑C.MIN.MONTHLY&EACH TIME SYSTEM OPERATED' 490-49 Allowed for monitorin of unburied emerSwcy Smerator fuel piping only er HSC§25281.5 bx3) ❑ 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 ❑ 99.OTHER(Specify) 490-52 490-53 UPCF UST-D(12/2007)1/4