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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN- Pa e 1 of 2) TYPE OF ACTION ❑ 1.NEW PLAN ® 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): 'ORM' T ON FACILITY ID#(Agency Use Only)_ BUSINESS NAME(Same as Faciltty Name or DBA) H & M MARKET 3. BUSINESS SITE ADDRESS 103. CITY ESCALON, CA. 104. 2501 JACKSON AVE. 95320 "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.Such work must be performed byuq alifiedpeersonnel.123 CCR§2632,2634,2638,26411_ MONITORING EQUIPMENT IS SERVICED ® 1.ANNUALLY [199.OTIIER(Specify): _ 490.36. �II1Vl�YI ' G LOCATI®N►S .: ❑ 1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN ® 2.SITE PLOT PLANIMAP PREVIOUSLY SUBMITTED (23 CCR§2632,26341 4904. I . TANK IVIONiTQRING:I PERI' '® _ Imo_' � .0 �OF� ,OWING"METH®D(S) that j4)1 1. 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: ® a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED ❑ d.UNDER VACUUM 490.6. PANEL MANUFACTURER: VEEDER ROOT 490-7. MODEL#: TLS-350 490.8. LEAK SENSOR MANUFACTURER: VEEDER ROOT 490-9' MODEL_#(S): 420 490-10. 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).[23 Ica.§26431 490-11. PANEL MANUFACTURER: 490'12' MODEL M 490-13, IN-TANK PROBE MANUFACTURER: 490-14. MODEL#(S): 490-I5. LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY 490-16• ❑ d.MONTHLY ❑ e.OTHER(Specify): 490.17. _ PROGRAMMED TESTS: Ela.0.1 g.p.h. F1b.0.2 g.p.h. ❑ c.OTHER S eci -490-19. 49°'15' ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.11 490.20. ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)[23 CCR§26451 TESTING PERIOD: E] a.36 HOURS ❑ b.60 HOURS 490-22.0- 90 22 21 ❑ 5,TANK INTEGRITY TESTING PER 123 CCR§2643.11 490-23. TEST FREQUENCY: ❑ FRE UENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY c.OTHER(S_ec_i 490-25. 490-26 99.OTHER(Specify): 490.2Z 24. PAPE MMaiNIT�RINfz,IS PEItI'OR9(IG CTING TILE F®Ial.OIN( IMETH®lD(S) flwiel �, .. ® 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE&VISUAL ALARMS. 490-2g.. [§26 6] SECONDARY CONTAINMENT IS: ® a.DRY C1 b.LIQUID FILLED ❑ c.PRESSURIZED ❑ d.UNDER VACUUM 490.29' PANEL MANUFACTURER:VEEDER ROOT 490'30• MODEL#: TLS-350 490.31. LEAK SENSOR MANUFACTURER: VEEDER ROOT '90.3x' MODEL#(S): 208 490-33. 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 490-35. ® 2.MECHANICAL LINE LEAK DETECTOR(MLLD)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 MLLD MANUFACTURER(S):MLD/RED JACKET 490-37' MODEL#(s): LD2000/FX1V 490-39, ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS.(23 CCR§26361 490.39. I 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 410-41- ELLD FAILUREIDISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ❑ b.NO 490.44. I ❑ 4.PIPE INTEGRITY TESTING. 49090-45. I _ 046. TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(Specify) 490 4x7. ❑ 5,VISUAL PIPE MONITORING. 49048. FRF,QUENCY: ❑ a.DAILY ❑ b.WEEKLY ❑ C.MIN.MONTHLY&EACH TIME SYSTEM OPERATED* 490-49• 'Allowed for monitoring of unburied emergency generator fuel pipit.on er HSC X2528 L.sfb, ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA.[23 CCR§2636(-)(3)1 490-50' ❑ 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM. _49090-51.� ❑ 99.OTHER(Specify) "-490-52. 490-53. UPCF UST-D(12/2007)-1/6 www.unidoes.org