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f. IED PROGRAM CONSOLIDATED Fonim UNDERGROUND STORAGE TANK MONITORING PLAN- (Page 1 of 2) TYPE OF ACTION ❑ 1.NEW PLAN 7 2.CHANGE OF INFORMATION 490-1. AN 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): F C _ Y FORMA ON" FACILITY ID#(Agency Use Only) t BUSINESS NAME(Same as Facility Name or DBA) *4 3." BUSI ESS SITE ADDRESS 103. CITY 104. y ,4 ' " )C 4 C-R-1w II :EQU,VP`TESTING ° PRE ENT MAINTENAN 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.Such work must be,performedb qualified personnel.[23 CCR§2632,2634,2638,2641] EQUIPMENT IS SERVICED 1.ANNUALLY ❑ 99.OTHER490-3e. MONITORING E Q � (Specify): 490-3b. ❑ 1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN [K 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED [23 CCR§2632,2634) 490.4. AlT1�NIONI '� { P # R 1WY]L+x 1TSIl' GI +' I+' G MTTO�(5) �haheck all y7 . 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) 490-5. WITH AUDIBLE AND VISUAL ALARMS.[23 CR§2632,26341 SECONDARY CONTAINMENT IS: 06 a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED ❑ d.UNDER VACUUM 490-6. PANEL MANUFACTURER: /- L 490-7. MODEL#: ,Q [3 490-8. .. 90.9. 490.10. LEAK SENSOR MANUFACTURER: a ® MODEL#(S): ,�.Q t„�S .. ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITO 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 TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY 490-16. ❑ d.MONTHLY ❑ e.OTHER(Specify): 490-]z PROGRAMMED TESTS: ❑ a.0.1 g.p.h. ❑ b.0.2 g.p.h. ❑ OTHER(Specify): 0-90-10-. ❑ 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 490-202. - ----....._..__.._... -- ----------- -._.-..._._.._............__.._....._.._._......._..._............ ._......._._._._._..__....._..._...._.._...__..._._..._.__......._...-----^ 5.TANK INTEGRITY TESTING PER[23 CCR§2643.1] 490-23. FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER490-z4. TEST FRE Q (Specify):, � 4( ago-zs. ❑ 490-26. 99.OTHER(Specify): a9az7. a' PPE MT + �� t�PER� D5 `OL� ..MFiTT ® ( ) (Cteckall that' 1 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE&VISUAL ALARMS. 490-28. [23 SECONDARY CONTAINMENT IS: Za.DRY [_1b.LIQUID FILLED [3c.PRESSURIZED Eld.UNDER VACUUM 490-29. PANEL MANUFACTURER: j -At 490-30. I„MODEL#: 0-Q -Le 490-31. r 490 2. LEAK SENSOR MANUFACTURER: f L�'�eQSA-La ,S' ems' MODEL#(S): �.�.4L.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 ❑ b.NO 490-35. ❑ 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§2636] 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): 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. 49042. 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 49044. ...................-.........................._.................._.............................................................._......................................_........._........_...._........._.................._......_..........------...__.._.._......... _......_... ---- ------ [�4.PIPE INTEGRITY TESTING. q 49045. _ 046. ( P �) A S �q �j iA e:j 497. TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS - ❑ c_OTHER S eciG a9o42 El5.VISUAL PIPE MONITORING. 0-9645. FREQUENCY: ❑ a.DAILY ❑ b.WEEKLY ❑ c.MIN.MONTHLY&EACH TIME SYSTEM OPERATED* 49049. Allowed for monitoring of unburied_emeren�generator fuel pipinj�o per HSC§25281.5(b)(3) _ ......_..-----.........._ ........._........._.... ................ ....................................._....--.-__. or 6.SUCTION PIPING MEETS EXEMPTION CRITERIA.[23 CCR§2636(a)(3)] a9aso. .................................................._.........._.......................................-.._.._......---....._...._...................._......_......._...._... --...................................._.................._..._...........---.....---.................................._......_.-.-- ------------- __...._..-.._.__.................. ❑ 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) a9o-52. 49,';12. UPCF UST-D(12/2007)-114 www.unidoes.org