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11/3012004 11:05 9163731 b� WALTON ENGINEEJ& PAGE 02
<br />UNDERGROUND STORAGE TANK MONITORING PLAN
<br />F'or Ice by Unidocs Member Agencies or where approved by your Local Jurisdiction
<br />Authority Cited: Title 23 CCR, Sections 2632(d)(1), 2634(4)(2), and 2641(h)
<br />TYPE OF ACTION ❑ 1. NEW PLAN ❑ 2. CHANGE OF INFORMATION
<br />IO
<br />M01
<br />PLAN TYPE R MONITORING iS IDENTICAL FOR ALL USTs AT THIS FACILITY.
<br />M02.
<br />Check one item only) ❑ THIS PLAN COVERS ONLY THE FOLLOWING LIST,$YSTEM(S):
<br />1. FACILITY INFORMATION
<br />FACILITY ID # (Agency Use Only)
<br />FACILITY NAME Ronfare Market #35
<br />M03.
<br />FACILITY SiTE ADDRESS 15 W. Gralltfille Road 0CITY
<br />Tracy
<br />Mo'.
<br />II- EQUIPMENT TESTINGA.N1) AREVENTIVE.MAINTENANCE
<br />State law requires that testing, preventive maintenance, and calibration of monitoring equipment (e,g„ sensors, probes, line leak detectors, etc.) be performed in
<br />"�nr,.
<br />accordance with the equipment manufacturers' instructions, or annually, whichever is more frequent. Such work must be performed by qualified personnel.
<br />F
<br />MONITORING EQUTPM.NT IS SERVICED ® 1, ANNUALLY (D99.OTHER (Specify):
<br />Moi.
<br />11I:4- MONITORING .LOCATIONS
<br />This monitoring plan must include a Site Plan showing the general tank and piping layouts and tic locations where monitoring is performed (i,c„ location of each sensor,
<br />line Icak detector, monitoring system control panel, ctc,), If you already have a diagram (e.g., current UST Monitoring Site Plan from a Monitoring Systcm Certification
<br />form, hazardous Materials Husincm Plan mgp, etc.) which shows all re uircd information, include it with this plan.
<br />IV. TANK MONITOWNG
<br />MONITORING IS PERFORMED USING THE FOL.i3OWING METHOD($): (Check all that apply)
<br />Mtn•
<br />® I, CONTINUOUS ELECTRONIC MONITORING OF TANK, ANNULAR (IN3'FRSTTTIAL) SPACES) OR SECONDARY CONTAINMENT VAULT(S)
<br />SECONDARY CONTAiNMENT iS: R a, DRY ❑ b, LIQUID FILLED ❑ c, UNDER PRESSURE ❑ d, UNDER VACUUM
<br />M"
<br />PANEL MANUFACTURER; Veeder-Roo M12 MODEL #: TLS 350
<br />M11'
<br />LEAK SENSOR MANUFACTURER: Veeder-Root M14. MODEL #(S): 794390-460
<br />MI5.
<br />❑ 2, AUTOMATIC TANK GAUGING (AT(3) SYSTEM USED TO MONITOR SINGLE WALL TANK.(S)
<br />PANEL MANUFACTURER,- MM, MODEL 1f:
<br />M19.
<br />IN -TANK PROBE MANUFA(,-rUPER: Min. MODEL #(S):
<br />M'"'
<br />LEAK TEST FREQUENCY: ❑ a. CONTINUOUS b. DAILY/NIGHTLY ❑ c. WEEKLY
<br />Mao.
<br />❑ d, MONTHLY ❑ c. OTHER (Specify); M21.
<br />PROGRAMMED TESTS: ❑ a. 0.1 g.p.h, ❑ b. 0.2 g.p.h, c, OTHER (Specify); M22.
<br />M23,
<br />❑ 3, IN VbNTORV RECONCILIATION ❑ it. MANUAL PER 23 CCR §2(A6 ® b, STATISTICAL PER 23 CCR §2646,1
<br />M24
<br />❑ 4. WEEKLY MANUAL TANK GAUGING (MTG) PER 23 CCR §2645
<br />TESTING PERIOD; ❑ a. 36 HOURS ❑ b. 60 HOURS
<br />Mei.
<br />❑ S, INTEGRITY TESTING PER 23 CCR $2643,1
<br />TEST FREQUENCY; ❑ a. ANNUALLY ❑ b. BIENNIALLY ❑ C. OTHER (Specify): M26.
<br />M27.
<br />❑ 6,VISUAL.MONiTORiNG DONE: ❑ it. DAiLY ❑ b. WEEKLY (Requirwagancyapprvwl)
<br />❑ 99. OTHER (Specify);
<br />M2s'
<br />V. PIPE MONITORING
<br />MONITORING IS PERFORMED USiNG THE FOLLOWING METHOD(S) (Check all that apply)
<br />Man•
<br />® t. CONTINUOUS ELECTRONIC MONITORiNG OF PIPING SUMP(S)/TRENCH(E$) AND OTHER, SECONDARY CONTAINMENT
<br />SECONDARY CONTAINMENT IS: R a. DRY ❑ b. LIQUID FILLED ❑ c. UNDER PRESSURE ❑ d. UNDER VACUUM
<br />Mat.
<br />PANEL MANUFACTURER; Ve-ed.er-R Qt M32. moms, #; TLS 350
<br />M33,
<br />LEAK SENSOR MANUFACTURER, Veeder^Root M34' MODEL 1f(sy 794380-208
<br />Mas.
<br />WILL A PIPING LEAK ALARM TRI(Kjf3R AU`t0MA'rl(: PUMP (i,c.. TURUINE) SHUTDOWN? R a. YES ❑ b. NO
<br />M3R
<br />WiLL FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? R a. YES ❑ b. NO
<br />M17
<br />® 2. MECHANICAL LINE LEAK DETECTOR (MLLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS AND RESTRICTS OR SHUTS
<br />OFF
<br />PRODUCT FLOW WHEN A BEAK. TS I)F-,T sC'i-H0
<br />MLLD MANUFACTURER(s): Mag' MODEL
<br />R 3. ELECTRONIC LINE LEAK DETECTOR (ELLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS
<br />ELLD MANUFACTURFR; Y[Q,,?.F.[-RQQt 1 M40' MODEL #; 848480-001
<br />M41.
<br />PROGRAMMi5D LINt INTEGRITY TESTS: ❑ a. MiNIMUM MONTHLY 0,2 g,p,h, ❑ b, MINIMUM ANNUAL 0.1 g.p.h.
<br />M42.
<br />WILL ELLD DETECTION OF A PiPING LEAK TRiGGER AUTOMATIC PUMP SHUTDOWN? R n. YES ❑ h. NO
<br />M83
<br />WILL ELLD PAiLUREMISCONNECTTON TRIGGER AUTOMATIC PUMP SHUTDOWN? R a, YES ❑ b, NO
<br />M44.
<br />❑ 4. INTEGRITY TESTING
<br />l'E,S'r FPEQUENCY: ❑ a. ANNUALLY ❑ b. EVERY 3 YEARS ❑ c. OTHER (Specify) M4S.
<br />M46.
<br />❑ S.VISIIALMONITORING DONE: ❑ a. DAiLY ❑ b. WEEKLY* ❑ c, MiN. MONTHLY &EACHTIME SYSTEM OPERATED•*
<br />M47,
<br />' Rmirw ngtncy approval ^• Allowcd Ibr manitoring nruntmrled emergency gpnerata rite piping only W HSC l;25281.5(b)(3)
<br />E]6. PIPING 1S SUCTION PIPING MEETING ALL REQUTREMENTS FOR EXEMPTION FROM MONITORING PER 23 CCR §2636(a)(3)
<br />❑ 7. NO PRODUCT OR RF.,MOTF. FILL PIPiNG iS CONNECTED TO THE UST(s)
<br />❑ 99. OTHER (Specify)
<br />Moa.
<br />UN -022A - 115 www.unidocs.org Rev. 10/14/03
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