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IN 16;Q w IFIED PROGRAM CONSOLIDATED UNDERGROUND STORAGE TAN t MONITORING PLAN - (Pae I of 2) ZQ11 TYPE OF ACTION ❑ 1.NEW PLAN ❑ 2.CHANGE OF INFORMATION 0-90-I. PLAN TYPE ❑ 1.MONITORING IS IDENTICAL FOR ALL UST's AT THIS FACILITY. �,qr4� t fp'L 490-2. (Check one item only) ® 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): PRO2§Y1T}SFFkv1C�S I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) 1 BUSINESS NAME(Same as Facility Name or DBA) 3. Kaiser Permanente Medical Offices BUSINESS SITE ADDRESS 7373 West Lane 103. CITY Stockton 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 b the equipment manufacturers'instructions,or annually,whichever.is more frequent.Such work must be performed by qualified personnel.[23 CCR§2.632,z63a,2638.2641] Y.....-----. .._.. _...--- -..._.._._.......__.................- ..._........ ............._....._.._.__._. MONITORING EQUIPMENT IS SERVICED ® 1.ANNUALLY ❑ 99.OTHER(Specify): 490-38. Q ( p fy): 490-36. III. MONITORING LOCATIONS ❑ 1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN ® 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED490-4. [23 CCR§2632,26341 IV. TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) thatack�I ® 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) 490.5. WITH AUDIBLE AND VISUAL ALARMS.[23 CCR§2632,2634) SECONDARY CONTAINMENT IS: ® a.DRY ❑ b.LIQUID FILLED [l c.PRESSURIZED ❑ d.UNDER VACUUM 490-6. PANEL MANUFACTURER: Veeder Root 490-7. MODEL#: TLS-250 1 49, S. LEAK SENSOR MANUFACTURER: Veeder Root 490-9. MODEL#(S): 794390-409 490-10. ........................................................................_._..................._.........._.....---._._.._......._ .............................. ❑ 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. IN-TANK PROBE MANUFACTURER: 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. PROGRAMMED TESTS: ❑ a.0.1 h. ❑ b.0.2 h. c.OTHERS eci 4,,,-Is. ................_._........................................................._........._..............................._-...._....._.._.........----.._g g.p.h. ........._49014:............ ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION[23 CCR§2646.11 490-2.o. ......................_.............................._.........._....__....-'--.........._....-....._.._..............._.............._......................................................._............................._.......................--..........................._.....__.._...._._.____._....._.__.__.._..........................._......................._......._................................................................_........._..49..._....._..... ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)123 CCR§26451 TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS 49490-21 _.- ............................... -._.._......._._._.._......................................................---....__.._._.........................._.._.........._.............----..._.........._....----................_ _........................._..__......................_...._.............................._......_.........................................................._.............................................-............................ .... ❑ 5.TANK INTEGRITY TESTING PER[23 CCR§2643.1] 490-23. TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHERS eci' 490-, Q _...................._._. (.P 4`Y 4Go ............................_................_......._..._.._._.__...._._._....-.._....._................-_ ._._. _................................ - -...__........_._..._....._......_.......----- -.... __....__......._.. ...... ❑ 99.OTHER(Specify): ago-is. 490-27. V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) (Cethatack all ® 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE&VISUAL ALARMS. 490-28. [23 CCR SECONDARY CONTAINMENT IS: ® a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED ❑ d.UNDER VACUUM 490-29. §2636] PANEL MANUFACTURER:Veeder Root 490-30. MODEL#: TLS-2550 1 490-31. LEAK SENSOR MANUFACTURER: Veeder Root 490-32. MODEL#(S): 794390-205 490-33. 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 ® 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 490-36. PRODUCT FLOW WHEN A LEAK IS DETECTED.[23 CCR§26361 490-37. 490-38. MLLD MANUFACTURER(S): MODEL#(S): ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS.[23 CCR§26361 490-39. ELLD MANUFACTURER(S): 49040. 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/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ❑ b.NO 490-44. ......................_........_.............................----....................---._.-..._..__-..-----------_.....---- --........._..._......._...._........._....................._._......_.........................................................--._..........._.. ---..........._..__..-............_.......__._._..._......_..............................................._...... ❑ ago-as. 4.PIPE INTEGRITY TESTING. 490-46. TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(Specify) avo4�:...-_...... ......_._....._...._._._._.... _-- ........._ ..._........ _......_.._.._.................................._......_..._....._.__..........._....._..._.-._.__... ---- -..__.....--.._._.._.........._._....__._..._.....__...._..._....._........_._......__... ® 5.VISUAL PIPE MONITORING. 49048. FREQUENCY: ❑ a.DAILY ❑ b.WEEKLY ® c.MIN.MONTHLY&EACH TIME SYSTEM OPERATED- 49049. "Allowed for monitoring of unburied.emergency generator fuel piping,only,per.HSC;22528 L5(b)(3) .._......_._....._._..............._...._.___......... ..-------.._...._._._................I_...__............_................_.11.................._...__...---................._..-----.._.. _..-_............_ 49050 ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA.[23 CCR§2636(8)(3)1 ........__ ... ......... . ..............._......_.................._..........--_............................__._.._........._...... - -... __..........._.._.... ...................... _....................... _.._....._... ❑ 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM. 90-51, ..................................._................................................_...__.._......._._._...._...................................................._.._..............._.........-..__.._......_._._................_._............_......................................................._............................................................................................_.................................. ._4904......-5_.......2...... ❑ 99.OTHER(Specify) 490-53. 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