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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN — (Pae 1 of 2) TYPE OF ACTION ❑ I NEW PLAN CS 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(S): I FACILITY INFORMATION FACILITY ID # (Agency Use Only) l BUSINESS NAME (Same as Facility Name or DBA) a CRL -C t a75-gq(o BUSINESS TE WU S CM9 B VCL to3 (,/ /�� CI [y , W�0 toa 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 b the equipment manufacturers instructions, or annually, whichever 1s more frequent. Such work must be performed by qualified personnel [23 CCR §2632 2634 2638, 26411 _y 4000 - ._...._ whichever ._.._. _ -- — _ .__ _ . MONITORING EQUIPMENT IS SERVICED ❑1. ANNUALLY ❑ 490-3a 99. OTER ( ecify): 490-3b. III. MONITORING LOCATIONS ❑ 1 NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN ® 2 SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED [23 CCR §2632.2634] 4904 IV. TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) hatak ) ❑ 1 CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR (INTERSTITIAL) SPACE(S) OR SECONDARY CONTAINMENT VAULT(S) 490-5 WITH AUDIBLE AND VISUAL ALARMS (23 CCR §2632,26341 SECONDARY CONTAINMENT 1S: ® a DRY4b LIQUID FILLED ❑ c PRESSURIZED d UNDER VACUUM 490.6 PANEL MANUFACTURER: 490-7 MODEL #: -FLS 490-8 -FLS LEAK SENSORMANUFACTURER: 490-9 MODEL #(S): 490.10 _._ 4..4..400000-. .00000000---0000-- ❑ 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 TESI FREQUENCY: ❑ a CONTINUOUS ❑ b DAILY/NIGHTLY ❑ c WEEKLY 490-16 ❑ d MONTHLY ❑ e OTHER (Specify): 490-17 490-18 907[. _- PROGRAMMED TESTS: ❑ a_0 l p h D b. 0 2 g.p,h ❑ c OTHER (Specify). _ 4.9.071.9-20 ❑ 3, MONTHLY STATISTICAL INVENTORY RECONCILIATION (23 CCR §26461] a90•zo ❑ 4 WEEKLY MANUAL TANK GAUGING (MTG) [23 CCR §2645] TESTING PERIOD: ❑ a. 36 HOURS [Ib 60 HOURS 492-z1 - 490-22. _-_`. _.. .........__ 44.4...4........ _.....•._ _-.._._._ __ _.. _ _.-..__ . _._ _. _.__ _. -_.. - ... __._... _._. . ......_.. _... ........ ..4400---.. _._._ ..._--- _._ ❑ 5 TANK INTEGRITY TESTING PER [23 CCR§2643 11 490-23 490-24 TEST FREQUENCY: a ANNUALLY ❑ b BIENNIALLY ❑ c OTHER (Specify): 490.25 ❑ 99. OTHER (Specify):490-27. -27. V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) "he"apply) ❑ 1 CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S) AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE & VISUAL ALARMS 490.28 (13DRY El LIQUID FILLED El PRESSURIZED ❑ d. UNDER VACUUM ago -z9 SECONDARY CONTAINMENT IS:^^ 1a1 PANEL MANUFACTURER: C.Ca� 490.30 MODEL #: Z_S SSS 490-31 LEAK SENSOR MANUFACTURER: 490-32 MODEL #(S): 490-33 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP (i c, TURBINE) SHUTDOWN ❑ a YES ❑ b NO 490-34 FAILUREIDISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a. YES ❑ b NO 490-35 --------.. _.... .. _ ._---- -0000-- � --- 0000- -----...4.4.44..__....._ ...4..000--.._... ❑ 2 MECHANICAL LINE LEAK DETECTOR (MELD) THAT ROUTINELY PERFORMS 3 0 g p h LEAK TESTS AND RESTRICTS OR SHUTS OFF 490-36 PRODUCT FLOW WHEN A LEAK IS DETECTED [23 CCR§26361 MELD MANUFACTURER(S): 490.37 � MODEL #(S): 490-38 _...._ 4 0000 0 00--000..4 ._ ❑ 3 ELECTRONIC LINE LEAK DETECTOR (ELLD) THAT ROUIINELY PERFORMS 3 0 g p h LEAK TESTS [23 CCR§2636] 490-39 ELLD MANUFACTURER(S): 490-40 MODEL #(S): 49041 PROGRAMMED IN LINE LEAK TEST: ❑ a MINIMUM MONTHLY 0 2 g p h ❑ b 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/DISCONNECTIONTRIGGERS AUTOMATIC PUMP SHUTDOWN ❑ a. YES ❑ b NO 490.44 _.... _ ..44...4.4 _...__ - -.,._..... __ .. _... ._.. .. . _ ........-._. ❑ 4 PIPE INTEGRITY TESTING 49045 0-46 TEST FREQUENCY: ❑ a- ANNUALLY ❑ b. EVERY 3 YEARS ❑ c OTHERS ci 497 Q--.. (. >.. 4..490 _.. ..._. ...... _.._.-...-_-._._.---.-__............_...__............. __..._. .... .-'_--_._. -_ 0000 __... _ _ ._ --- __ - ❑ 5 VISUAL PIPE MONITORING d90 -de FREQUENCY: ❑ a DAILY ❑ b WEEKLY ❑ c MIN MONTHLY & EACH TIME SYSTEM OPERATED. 490-49 • Allowed for mnitoring c f unburied,emergency generator fuel piping mly_per HK§252915 bL(3) ..___..-._ __.-4.4...4.4__...... ...._.... _.._ ._... __..--_...._.. ._- _. ..4444-_ _.... __. ..4.4.44 ..._....--- ❑ 6. SUCTION PIPING MEETS EXEMPTION CRITERIA(23 CCR §2636(a)(3p 490-50 - ❑ T NO REGULATEDPIPING PER HEALTH AND SAFETY CODE, DIVISION 20, CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM. 490.51 4444_. _..._... 4...4 00 ....... ......._.. __... ❑ 99. OTHER (Specify) 490.52 490-53. UPCF UST -D (12/2007) - 1/4 www.unidocs..org