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U FLED PROGRAM CONSOLIDATED FORM UNDERGROUNDSTORAGETANK 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 UST.,AT THIS FACILI'T'Y. 490-2. (Check one item only) ❑ 2.THIS PLAN COVERS ONLY•THE FOLLOWING U'S'T'SYSTENI(S): I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) t. BUSINIESS NAME(Same as l:acdity Vame or DBA) 3' K�AhCfe C int fA�+ws•✓('� r BUSINESS SITE ADDRESS 103. 1 CITY tea X777 iM-%--4Tt4_A I . EQUIPMENT TEST G AND PREVENTIVEIAC Testing,preventive maintenance,and calibration of monitoring equipment(e.g.,sensors,probes,line leak detects,:s,etc.)must be performed at the frequency specified by the equipment manufacturaars'instructions,or annually,whichever is more frequent.Such work must be performed by qualified personnel.[23 CCR§2632,263k 2638.26411 490-3a. MONITORING EQUIPMENT IS SERVICED L ANNUALLY ❑ 99.OTHER(Specitv): 490-31 III. MONITORING LOCATIONS ❑ 1.NEW SITE PLOT PLAMMAP SUBMITTED WITH THIS PLAN ❑ 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED 123 CCR 22632,2('31] g40-4. IV. TANK MONITORING IS PERFORMEDUSING THE FOLLOWING (S) a heel`,n Q 1.CONTINUOUS ELECTRONIC TANK N10NITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) 490.5. WITH AUDIBLEAND VISUAL ALARMS.123 CCR§2632,26341 SECONDARY CONTAINMENT IS: ❑ a.DRY Q b.LIQUID FILLED ❑ c.PRFSSUR17.FD ❑ d.UNDER VACUUM 4906. PANEL MAN'U'FAC;I'URER: iD•,,�nr, L„,r„®.,,ta 490-7. MODEL#: 490-8. LEAK SENSOR MANUFACTURER: 490-9- MODFL#(S): 490-10. .......... ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).[23 CCR§26431 490 11. PANEL MANUFACTURER: 490-12" MODEL#: 490-13. ]INT-T INK PROBE M'LANNUFACTUT.ER: 490-14. MODEL#(S): 490-15. LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c•WEEKLY 490-16. ❑ d.MONTHLY ❑ e.OTHER(Specify): 490-17.400-18. PROGRA]bRIED TESTS: ❑ a.0.1 g.p.h. ❑ b.0.2 g.p.h. ❑ e.OTIIER(Specify): 499-19. ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION 123 CCR 62646.11 490-20. ❑ 4.WEEKLY MANUAL,TANK GAUGING(MTG)[23 CCR P6451 TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS 490 22. 1 _ __ -- -- ...__._._._._..._ ....... _._.._.. _ __.......... . ....__._...... .._.. -- .. ❑ 5.TAINl'EGRITY TESTING PER[23 CCR§2643.11 ago-TANK 490-20-. TIKST FREQUENCY: ❑ a.ANNUALLY ❑ h BIENNIALLY ❑ c.O'T'HER(Specify): 49490- _.. ...... -9__._..... 99.OTHER(Specify): 490�6 ❑ ( P - ): 1 y:.t✓�i. � �-'i.�. 0-90-27. V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING ET (S) (Check all thud apply) 1.CONTINUOUS MOivIT`ORING OF PIPF/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE&VISUAL ALARMS- 49x28' 123 CCR SECONDARY CONTAINMENTIS: a.DRY ❑ b.LIQUID I-ILLED ❑ c.PRESSURIZED ❑ d.UNDER VACUUMS 490-29' §"b35J PANEL MANUFACTURER: 1 :+;G.+•' L+.: +i; 4901W MODEL#: 490-31. LEAK SENSOR MANUFACTURER: iZ�,.+ ,.► 490-30-. ;,,IODEL#(S): 490-33. PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e...TURBINE)SHUTDOWN. ❑ a.YES ® b.NO 490-34' FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a-YES JZ b.NO 490-35. .. _ _. - - ...... _.- --- -- - -- - - ❑ 2 MfECHA]VICr1L LINE LEAIa DETECTOR(MELD)THAT RO[J'fINELY PF.RFORsViS 3-0 g.p.h.LEAK TESTS AND RESTRICTS OR SHUTS OFF 49a3o. PRODUCT FLOW WHEN A LEAK IS DETECTED.123 CCR§26361 MLLD MANUFACTURER(S): 490-37. MODEL#(S): 490.38. _. ...... 490-39. ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS.123 CCR§26361 ELLD MANUFACTURFR(S): 49440. MODEL tl(S): 490-41. PROGRAMMED INT LINE LEAK TEST: ❑ a.NIINIMUN4 MONTHLY 0.2 g.p.h. ❑ b.MIN MU.M ANNUAL 0.1 g.p.h. 49x42. ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ❑ b.NO 49043. ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ❑ b.NO 490-44. ❑ 4.PIPE INTEGRITY TESTING. 490-45' _ . _ - 0-90-0-6. TEST FREQUENCY: a.ANNUALLY b.EVERY 3 YEARS c.OTHER(S ecify) 0-80-47. ❑ 5.VISUAL PIPE MONITORING.... 490-48. FREQUFNCY: [Z a.DAILY ❑ b.WEEKLY ❑ c.r.SIN.MONTHLY&EACH TIME SYSTEM OPERATED' 490-49. _......__..-._"Alluwer!fur newuturir. _f wrluriul ewer8e,ay.8areratur fuel Iutw nJy pet HSC?i25281.5(bx3).- ❑ 49G-50.6.SUC11ON PIPING MEET'S EXEMP'lION CRITERIA.123CCR§2636(a)(3)l ---... ........ ---. ...._.....__.._...__....__._......... -._....... ... - __.._.................. 1 [� 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO TI IE TANK SYSTEM. 4°s' _.-._..... ....... ........-.. _. ...... ._ ......._ .. _.. _.._.._...._...._........................ -._...._._ . ._ _ _._...._._ . . ....... ❑ 99.OTHER(Spcoif) 490-53. . ItPCF UST-D(1=007)-114 www.uniducs.org