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` UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN— (Page 1 of 2) IYPE OF ACTION ❑ 1 NEW PLAN [g 2 CHANGE OF INFORMATION 490-1 PLAN 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): 1 FACILITY INFORIVIATIQN„ FACILITY ID#(Agency Use Only) ITTT BUSINESS NAME�as a�ry Name or D�� 3 BUSINESS SITE DRESS (,,�(,,i 103 CIT toa � t � -b q d . � M� T�'ESTIN ANDSPI2F'VIi TI T0- x y Testing,preventive maintenance,and calibration of monitoring equipment(e g.,sensors,probes,line leak detectors,etc.)must be performed at the frequency specified the eq!j!n nt manufacturers'instructions,or annually,whichever is more frequent.Such work must be performed�y qualifiedpersonnel. gR§z63z,263°,2638,26411 MONITORING EQUIPMENT IS SERVICED y�14Wia �.ANNUALLY i ❑*99.OTHER(Specify): 490-3b. ❑ I NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN ® 2.SIIE PLOT PLAN/MAP PREVIOUSLY SUBMITTED490-4 [23 CCR§2632,2634] 1 CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S) 490-5 WITH AUDIBLE AND VISUAL ALARMS (23 CCR§2632,26341 SECONDARY CONTAINMENT IS: C9 a DRY ❑ b LIQUID FILLED ❑ c.PRESSURIZED ❑ d UNDER VACUUM 490-6 PANEL MANUFACTURER: 490.7 MODEL#: 71—S :3157) 490-8 _ LEAK SENSOR M_ANUFACIURER: 490-9 MODEL#(S):..r0.90-10 ❑ 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/NIGHILY ❑ c WEEKLY 490-16 ❑ d,MONTHLY ❑ e OTHER(Specify): 490-17 PROGRAMMED TESTS: C1 �: a.0 1 h ❑ b.0.2 h. ❑ c.OTHERS i 4997 0-18 _._.._._... -P',-ECO N_C_1L__1A' _T'1 �Q�.fY)�.. .ago-19--- ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION[23 CCR§2646.q 490-20 .—._-----.____—..-----------.._...._____._ _.._------------------`—•------.......__.__...__...___._..----..._...._._..._.____...._.- 90- _-._. ❑ 4.WEEKLY MANUAL TANK GAUGING TG [23 CCR§2645] TESTING PERIOD: ❑ a.36 HOURS ❑ b.,,600.90- HOURS °9x21 ❑ -5-.-TANK INTEGRITY TESTING PER[23 CCR§264311 490-23 IESTFREQUENCY: ❑ a ANNUALLY ❑ b.BIENNIALLY Elc.c.OIHER(Specify�. 4W25.__,_ ❑.99.OTHER Secify): - --- - - 490-26 490.27. y :'ria "' - ""� 2 §xa 4 �A ",� • I CONTINUOUS MONITORING OF PIPEIPIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE&VISUAL ALARMS 490-28. [§26361 SECONDARY CONTAINMENT IS: 9 a DRY El b.LIQUID FILLED ❑ c PRESSURIZED El d.UNDER VACUUM 0.90-29 PANEL MANUFACTURER: QX 490-30 MODEL#: T(, 490-31 LEAK SENSOR MANUFACTURER: 490-32 MODEL#(S): a0g 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 490-31. ❑ 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§26361 _M_LLD MANUFA_CTU_RE S);_ 490-37 MODEL#(S)_ 490-39. ❑ 3 ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUIINELY PERFORMS 3 0 g p h LEAK TESTS.[23 CCR§26361 490-39. ELLD MANUFACTURER(S): 490.40 MODEL#(S): 490-41 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 490-41 ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ❑ b.NO 490-44 ❑ 4 PiPEINTEGRTTYTESTING. •- 490-45 TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(S ci 490.46 ❑ 5.VISUAL PIPE MONITORING. 490-48 FREQUENCY: ❑ a DAILY ❑ b WEEKLY ❑ c MIN.MONTHLY&EACH TIME SYSTEM OPERATED* 490-49 ---- _ ------__--- _._ _ .`_-Allowed for monioodn�of unburied amergenyy.�enaatot fuel ppingo"�mer HSC 2§5281.5(b�.,.... ❑ 6.-__SUCTION_____--- PIPING------ME—_—EIS---EXEMPTION—_— CRITERIA.(z3 ccR§2636[a1[3)1 490-50. ❑ 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM. 490"51. ❑ 99.OTHER(S eci ) 490sz 490-53. UPCF UST-D(12/2007)-1/4 www.unidocs.org