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UNIFIED RAM CONSOLIDATED FORM <br /> UNDWROUNDSTORAGETANK <br /> MONITORING PLAN- Pae 1 of 2) <br /> TYPE OF ACTION ❑ 1.NEW PLAN ® 2.CHANGE OF INFORMATION 490-1. <br /> PLAN TYPE ® I.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. 490-2. <br /> (Check one item only) ❑ 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): - _ _ Formatted;Font color:Auto <br /> I. FACILITY INFORMATION Formatted:Font Color:Auto <br /> FACILITY ID#(Agency Use Only) _ _ 1 <br /> BUSINESS NAME(Same as Facility NameQr DBA) ... ....._...... ..._....__........._._ .. "....__ ..3_. - - - Formatted:Font color:Auto <br /> Kaiser-Manteca Medical Center <br /> BUSINESS SITE ADDRESS 103, CITY 104, - - Field Code Charged <br /> 1777 W.Yosemite Ave Manteca <br /> II. EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE <br /> Testing,preventive maintenance,and calibration of monitoring equipment(e.g.,sensors,probes,line leak detectors,etc.)musjbeperformed at the frequency specified_ ..". - FOfloOtted:Font color:Auto <br /> by the equipment mmufacturers'instructions_or annuallywhichever is more_frequeej`Such work must beperformed byte ualified_�ersonnel.123 ccR 4?63=2634,2638,2641 <br /> MONITORING EQUIPMENT IS SERVICED ® I.ANNUALLY ❑ 99.OTHER(Specify): 99900.3'.: Fomatted,Font color:Auto <br /> III. MONITORING LOCATIONS Forn a ted:Font color:Auto <br /> ❑ 1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN ® 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED [23 CCR§2632,26341 490-4. <br /> IV. TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) 'ka�oka° Formatted:Font color Auto <br /> ® 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) 490-5. <br /> WITH AUDIBLE AND VISUAL ALARMS.123 CCR 12632,26341 <br /> SECONDARY CONTAINMENT IS: ❑ a.DRY ® b.LIQUID FILLED ❑ c.PRESSURIZED ❑ d.UNDER VACUUM 490-6. <br /> PANEL MANUFACTURER- 01HKA>i C0913iAg 490-3. MODEL#: ChWIM COMiag 490-8. <br /> LEAK SENSOR MANUFACTURER: Roma seneor 490-9. MODEL#(S). RS-10R 49o-t0. <br /> 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE W ALL TANK(S).[_3 CCR$±643] °90-11. <br /> PANEL MANUFACTURER. 490-12. MODEL#: 490-13. <br /> IN-TANK PROBE MANUFACTURER: 490-14. MODEL#(S)- 490-15. <br /> LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY 490-16. <br /> ❑ d MONTHLY ❑ e.OTHER(Specify): 490-17. <br /> PROGRAMMED TESTS: ❑ a.0.1 g.p.h. ❑ b.0.2 g.p.h. ❑ c.OTHER(Specify)- 490-18. <br /> _......_ )�.... .. ........._.. _-._._.._- 490-19_-_. <br /> ❑ 3 MONTHLY STATISTICAL INVENTORY RECONCILIATION[3 CCR 4 64611 ..._ _ ,,,,... -- --_- -_- ° - - Formatted:Font CDIM:Auto <br /> 90 0. <br /> - <br /> ❑ 4 WEEKLY MANUAL TANK GAUGING(MTG)[23 CCR§26451 TESTING PERIOD ❑ a 36 HOURS ❑ b 60 HOURS 490-90-1. <br /> ...... ------ -..._...-- -- ._..__ ...... _ _...._. ... - --- - ----- - - - -_ <br /> ❑ 5.TANK INTEGRITY TESTING PER[23 CCR$2643.11 490-23. <br /> TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHERS <br /> (Specify)- 490-24. <br /> 490-±5. <br /> ❑ 99.OTHER(Specify): 490-26. <br /> ago_7 <br /> V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) fCahQkau <br /> 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMPS AND OTHER SECONDARY CONTAINMENT U <br /> WITH ADIBLE VISUAL ALARMS. 490-28. <br /> ® ( > �`-- --------....- -- --.- --- - Fornwtted:Fonlor:Auto <br /> §2t co <br /> 121CCR361 C] C3M 49°'±9.SECONDARY CONTAINMENT IS: ® a.DRY b.LIQUID FILLED c.PRESSURIZED ❑ I UNDER VACUU <br /> $ <br /> PANEL MANUFACTURER- 490-30. 490-31. <br /> MODEL#: <br /> LEAK SENSOR MANUFACTURER: 490-32. MODEL#(S)-!S-31205 490-33. <br /> PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. ❑ a.YES ® b.NO 49034. <br /> FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ® b.NO 490-35. <br /> ❑ 2.MECHANICAL LINE LEAK DETECTOR(MELD)THATROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS AND RESTRICTS OR SHUTSOFF 490-36.- <br /> PRODUCT FLOW WHEN A LEAK IS DETECTED.123 CCR$26361 <br /> MLLD MANUFACTURER(S). 490-37. MODEL#(S): 4903H. <br /> ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS.123 CCR$26361 490-39. <br /> ELLD MANUFACTURER(S)- 490-°0' MODEL#(S)- 49041. <br /> PROGRAMMED IN LINE LEAK TEST: ❑ a.MINIMUM MONTHLY 0.2 g.p.h. ❑ b.MINIMUM ANNUAL 0.1 g.p.h. 490-42. <br /> ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ❑ b.NO 490-43. <br /> ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ❑ b.NO 490-44. <br /> ...._....-.__.. ......-.._...... ... ............ .....__._.. __........_. .. ..---- <br /> ._----. .... .............. ....._... 49045. <br /> ❑ 4.PIPE INTEGRITY TESTING. <br /> TEST FREQUENCY: ® a.ANNUALLY C1 b.EVERY 3 YEARS ❑.c_OTHER(Specify` _ _ - _a�4990-46. <br /> .._.._ ...... ..... ....._ ... ... - <br /> ❑ 5 VISUAL PIPE MONITORING. 490-08. <br /> R0 Font:Tin4es NewFREQUENCY: Ela.DAILY C1b.WEEKLY ® C.MIN 490-49.MONTHLY&EACH TIME SYSTEM OPERATED. Roman BOIL <br /> ._.__._..._ McTW f.r_ �brmH,.ofmtuned emeH.:.YH .._l.°�-f:.�Opmr,-_.-FISC]_25±81 SSDN3) __ <br /> C16.SUCTION PIPING MEETS EXEMPTION CRITERIA.123 CCR 12636(a)13)1 490-50" FOrmitted:Font:TInt25 New <br /> ___."._._._ ...._._. ..............---------------- -----"..._ ................. .... ......... ...._....... ......_.._... -------- ---..... ----- <br /> ❑ 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM. 490-51. Roman Bold,Font color:Auto <br /> .. .....___. "........_..._ ......_..... _._._...__....- ------- ------- ._-........ . . .............. .................. ............._..._. .......---..... ..------- ------- ----- <br /> 99.OTHERS c1 490-5. Formatted:Font:Tir NeW <br /> ❑ (Specify) 4vo-s3. <br /> UPCF UST-D(12/20071-J/5 www.oeidocLors _ .. <br /> Roman BOW,Font color:Auto <br />