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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN-LtLe I oft 490-1 TYPE OF ACTION 0 1.NEW PLAN 2.CHANGE OF INFORMATION PLAN TYPE 44 1,MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. 4942 (Check one item only) 0 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S)- 1. FACILITY INFORMATION FACILITY ID#(Agency Use Only) BUSINESS NAME(Same as FACILITY NAME) 3, BUSINESS SITE ADDRESS 103. 1 CITY 104. IL EQUIPMENTTESTINGAND PRIXENTIVE MAINTENANCE 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,and that such work must he performed by qualified personnel. _2LCC�R. 2632,�2634,2639,26412 490-33ba 90- MONITORING EQUIPMENT IS SERVICED 1.ANNUALLY 0 99.OTHER(Specify): 4 111.MONITORING LOCATIONS 0 1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN.y 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 2634)4w4 IV.TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT 4945 VAULT(S)WITH AUDIBLE AND VISUAL ARMS. (23 CCR§2632,2634) SECONDARY CONTAINMENT IS: O!La-DRY 0 b.LIQUID FILLED 0 c.PRESSURIZED 0 d,UNDER VACUUM 49D.6 ----------------------- 1 PANEL MANUFACTURER: 490-7. MODEL#: 3�_Vo 490-8 49040 LEAK SENSOR MANUFACTURER: MODEL#(S): 0 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE MALL TANK(S).(23 CCR§2643) 490-11 PANEL MANUFACTURER: 49 12. MODEL#: 490-13 IN-TANK PROBE MANUFACTURER: 490-14 MODEL#(S): 490-15 LEAK TEST FREQUENCY: El a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ e.WEEKLY 49416 d.MONTHLY ❑ e,OTHER(Specify): 490-17 ------------------------------- PROGRAMMED - TESTS: [I a.0.1&pA ❑F-1 b.0.2 g.p.h. ❑[I c.OTHER(Specify): 490-19 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 49420 490-21 C34.WEEKLY MANUAL TANK GAUGING(,MTG)(23 CCR§2645). TESTING PERIOD: C] a.36 HOURS ❑ b.60 HOURS 4%-22 0 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 41�)O 23 490-24 TEST FREQUENCY: ❑El a.ANNUALLY ❑[I b.BIENNIALLY ❑M c.OTHER(Specify): 49425 490-26 ❑99.OTHER (Specify): 490-27 V.PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) Z91.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 490-28 VISUAL ALARMS. (23CCR§2636) SECONDARY CONTAINMENT IS:Wa.DRY [3b.LIQUID FILLED Cle-PRESSURVED Eld.UNDER VACUUM ........ 490-29 : 490-31 PANEL MANUFACTURER: 'Zw-r- 49430 : MODEL#: LEAK SENSOR MANUFACTURER: 490-, 1 MODEL#(S)- 490-33 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. a.YES [I b.NO 490-34 FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. a.YES Ob.NO 490-35 2. CAL LINE LEAK DETECTOR(MLLD)THAT ROUTINELY PERFORMS 3.0 g.p.h. EAK TESTS AND RESTRICTS OR SHUTS OFF,,, PRODUCT WHEN A LEAK IS DETECTED(23 CCR§2L36A >4ff11 MLLDMANUFACTURER(S): 490-37 If MODEL j(S)7 ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.ph.LEAK TESTS (13 CCR§2636) 490-39 : ELLD MANUFACMANUFACTURERS) 490-40. S) ; MODEL#(S): 49041 PROGRAMMED IN LINE LEAK TEST: F1 1.MINIMUM MONTHLY 0.2 g.p.h. El 2.MINIMUM ANNUAL 0.1&p.h. ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. 0 a.YES C1 b.NO 490-431 ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. 0 a.YES 0 b,NO 490-44 C] 4,PIPE INTEGRITY TESTING 49045 TEST FREQUENCY El a,ANNUALLY 0 b.EVERY 3 YEARS [I c.OTHERS 494.46 490-47 El 5.VISUAL PIPE MONITORING. 490-48 FREQUENCY C3 a-DAILY [I b.WEEKLY El c.MIN-MONTHLY&EACH TIME SYSTEM OPERATED' 49049 *Allowed for monitainr of unburied emergemy Serem"fuer p'Ving oniy pa W§25281_ b 3) C3 &SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR§2636(a)(3)]. 490-50 rl 7,NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM 490-11 2 (Specify) 4 490-90-553 UPCIF UST-D(1212007)114