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09/24/2007 MON 13:55 FAX 2094683433 SJC EHD ********************* *** FAX TX REPORT *** ********************* TRANSMISSION OK JOB NO. 0569 DESTINATION ADDRESS 95776040 PSWD/SUBADDRESS DESTINATION ID ST. TIME 09/24 13:54 USAGE T 00'56 PGS. 3 RESULT OK UNDERGROUND STORAGE TANK MONITORING PLAN For use by Unidocs Member Agencies or where approved by your Local Jurisdiction Authority Cited.• Title 23 CCR, Sections 2632(d)(1). 2634(d)(2). and 2641(h) TYPE OF ACTION ❑ L NEW PLAN ® 2. CHANGE OF INFORMATION M01. PLAN TYPE ® MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. Moe. (Check one item only) ❑ THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): I. FACILITY INFORMATION FACILITY ID # (Agency Use Only) _ FACILITY NAME H & M MARKET Mol, FACILITY SITE ADDRESS 2501 JACKSON AVE. M04 CITY ESCALON, CA. 95320 Mos. II. EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE State law requires that testing, preventive maintenance, and calibration of monitoring equipment (e.g., sensors, probes, line leak detectors, etc.) be performed in M06. accordance with the equipment manufacturers' instructions, or annually, whichever is more frequent. Such work must be performed by qualified personnel. MONITORING EQUIPMENT IS SERVICED ® L ANNUALLY ❑ 99. OTHER (Specify): MOT III. MONITORING LOCATIONS This monitoring plan must include a Site Plan showing the general tank and piping layouts and the locations where monitoring is performed (i.e., location of each sensor, tine leak detector, monitoring system control panel, etc.). If you already have a diagram (e.g., current UST Monitoring Site Plan from a Monitoring System Certification form, Hazardous Materials Business Plan ma 2, etc.) which shows all required information include it with this plan. IV. TANK MONITORING MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): (Check all that apply) MIO. ® 1. CONTINUOUS ELECTRONIC MONITORING OF TANK ANNULAR (INTERSTITIAL) SPACE(S) OR SECONDARY CONTAINMENT VAULT(S) SECONDARY CONTAINMENT IS: ❑ a. DRY ❑ b. LIQUID FILLED ❑ c. UNDER PRESSURE ❑ d. UNDER VACUUM Mll. PANEL MANUFACTURER: VEEDER ROOT M12. MODEL #: TLS - 350 Mu. LEAK SENSOR MANUFACTURER: VEEDER ROOT M14. MODEL #(S): TLS - 350 MI5. ❑ 2. AUTOMATIC TANK GAUGING (ATG) SYSTEM USED TO MONITOR SINGLE WALL TANK(S) PANEL MANUFACTURER: M16. MODEL #: M17. 1N -TANK PROBE MANUFACTURER: MI6. MODEL #(S): MI°. LEAK TEST FREQUENCY: ❑ a. CONTINUOUS ❑ b. DAILY/NIGHTLY ❑ c. WEEKLY M20. ❑ d. MONTHLY ❑ e. OTHER (Specify): M21. PROGRAMMED TESTS: ❑ a. 0.1 g.p.h. ❑ b. 0.2 g.p.h. ❑ c. OTHER (Specify): M22. M23. ❑ 3. INVENTORY RECONCILIATION ❑ a. MANUAL PER 23 CCR §2646 ❑ b. STATISTICAL PER 23 CCR §2646.1 M24. ❑ 4. WEEKLY MANUAL TANK GAUGING (MTG) PER 23 CCR §2645 TESTING PERIOD: ❑ a. 36 HOURS ❑ b. 60 HOURS M2s ® 5. INTEGRITY TESTING PER 23 CCR §2643.1 TEST FREQUENCY: ® a. ANNUALLY ❑ b. BIENNIALLY ❑ c. OTHER (Specify): M26. M27. ❑ 6.VISUALMONITORINGDONE: ❑ a. DAILY ❑ b. WEEKLY mc*reaasemyappmi) ❑ 99. OTHER (Specify): M28. V. PIPE MONITORING MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply) Mao. ® 1. CONTINUOUS ELECTRONIC MONITORING OF PIPING SUMP(S)/TRENCH(ES) AND OTHER SECONDARY CONTAINMENT SECONDARY CONTAINMENT IS: ❑ a. DRY ❑ b. LIQUID FILLED ❑ c. UNDER PRESSURE❑ d. UNDER VACUUM Mll. PANEL MANUFACTURER: VEEDER ROOT M32. MODEL #: TLS - 35O "33 LEAK SENSOR MANUFACTURER: VEEDER ROOT M34. MODEL #(S): TLS - 350 M35. WILL A PIPING LEAK ALARM TRIGGER AUTOMATIC PUMP (i.e., TURBINE) SHUTDOWN? ❑ a. YES ❑ b. NO M36. WILL FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? ❑ a. YES ❑ b. NO M37. ® 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 DETECTED !S1