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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN-(Page 1 of 2) TYPE OF ACTION El 1.NEW PLAN El 2.CHANGE OF INFORMATION 490-1 PLAN TYPE [1 1.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. 490-2 (Check one item only) 0 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTE FACILITY ID#(Agency Use Only) BUSINESS NAME(Same as FACILITY NAME) Ake- M# 3. BUSINESS SITE ADDRESS 103, CITY 104. 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 be performed by qualified personnel. (23 CCR§2632,'2634,2638,2641) 490-3a MONITORING EQUIPMENT IS SERVICED JR 1.ANNUALLY 99.OTHER(Specify): 490-36b ❑1.NEW SITE PLOT PLANIMAP SUBMITTED WITH THIS PLAN. 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED, (23 CCR§2632, 2634)49o-4 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT 490-5 VAULT(S)WITH AUDIBLE AND VISUAL ALARMS. (23 CCR§2632,2634) SECONDARY CONTAINMENT IS: )9 a.DRY ❑ b.LIQUID FILLED C1 c.PRESSURIZED [I d.UNDER VACUUM 490-6 PANEL MANUFACTURER: e-e LD)e- 4910-Z�qI- MODEL#: 6-0 490-8 LEAK SENSOR MANUFACTURER: T 10-9. I MODEL#(S):0'79 513949- 4IA49 490-10 ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).(23 CCR§2643) 490-11 PANEL MANUFACTURER: 4111. MODEL#: 490-13 IN-TANK PROBE MANUFACTURER: 490-14 MODEL#(S): 490-15 LEAK TEST FREQUENCY: ❑ a.CONTINUOUS b.DAILY/NIGHTLY El 6.WEEKLY 490-16 ❑ d.MONTHLY El e.OTHER(Specify): 490-17 -------------------------- 4 ------------------------- 4 0-" PROGRAMMED TESTS: a.0.1 g.p.h. b.0.2 g.p.K El c.OTHER(Specify): 499.-19 -E] 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 490-20 ❑ 490-21 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§2645). TESTING PERIOD: ❑ a.36 HOURS 0 b.60 HOURS 490-22 C1 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 490-23 490-24 TEST FREQUENCY: E] a.ANNUALLY [I b.BIENNIALLY El c.OTHER(Specify): 490-25 0-99.OTHER (Specify): L,11jq,4 490-26 / ;W01)1;Vit1A)14- T�Ent�!c 490-27 T Ed 1,CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 490-28 VISUAL ALARMS. (23 CCR§2636) SECONDARY CONTAINMENT IS:0a,DRY Elb.LIQUID FILLED [3c.PRESSURIZED Od.UNDER VACUUM 490-79 ------------------ 490-30 : 490-31 PANEL MANUFAC MODEL#:7-,A, LEAK SENSOR MANUFACTURER: -0-96:3-2- MODEL#(S): 'Ro 490-11 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, Rra.YES [1b.NO 490-35 ❑ 2.MECHANICAL LINE LEAK DETECTOR(MLLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS AND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK IS DETEq[KP_(2 CCR?J _jL6j6J____ 490-36 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 MANUFACTURE!L(L) 49!f_LM2_�L#(S) C) 1 490-41 PROGRAMMED IN LINE LEAK TEST: ❑ 1.MINIMUM MONTHLY 0.2 g.p.h. El 2.MINIMUM ANNUAL 0.1 g.p.h. 490-42 ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. 0 a.YES [1 b.NO 49043 ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. P9 a.YES El b.NO 49044 ❑ 4.PIPE INTEGRITY TESTING 49045 TEST FREQUENCY [I a.ANNUALLY [I b.EVERY 3 YEARS 0 c.OTHER(Specify) 49046490-47 5.VISUAL PIPE MONITORING. 49048 FREQUENCY 9 a.DAILY 0 b.WEEKLY 0 c.NUN.MONTHLY&EACH TIME SYSTEM OPERATED* 490-49 *Allowed for monitoring of unburied ernergency generator fuel piping only per HSC§25281.5(b)(3) El 6.SUCTION PIPING MEETS EXEMPTION CRITERIA[23 CCR§2636(a)(3)]. 490-50 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM -�-1 490-52 9 0'- [1 99.OTHER(Specify) 49=1 UPCF UST-D(12/2007)1/4