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UNIFIED PROGRAM CONS01,1DATED FORM
<br /> UNDERGROUND STORAGE TANK
<br /> ONITORING PLATIN--(PaLl., I of 2
<br /> 7777
<br /> A1R t.
<br /> TYPE OF ACTION ❑ t.NEW PLAN 2 CHANGE Of IWORMATION
<br /> a N1.2.
<br /> PLAN TVPI:. 19�1,Mc3Nri'ORING IS IDFNTICAI F•YTR ALL EISTs ATTHIS FACILITY.
<br /> (Check one item only.) ❑ 2.'I HIS PIAN COVERS ONLY TI IF FOLLOWING UST SYSTF,MN:
<br /> I. FACILITY INFORMATION
<br /> FACILITY 1D#(Agency Ilse()nip) 171 1 LL�
<br /> BININESS NAME(.Srune as 1'4ci#itp Name(pr 1)l3A) a.
<br /> 13USINFSS SITE ADDRESS ttu CI It#
<br /> IL EQ MENT TESTING AND PREVENrrVE MAINTENANCE
<br /> resting,preventive maintenuncc.arid calibration of monitoring equipment(e.g.,sensors,probes,lips:[cak detectors,etc.)must be performed at the frequency specified
<br /> . by the ei]tei went manufacturers'instructions or annually,whic:hevcr is mon;frequent.Such work muit hcLxxtbmred by glairlifled rsemnc] Iza C.CieT2t32 zb34.2e,K 26411
<br /> qwm-3a.
<br /> MONITORING L ijulwmRNT IS SERVIr_li[7 (9 1 ANNI IALLY r-1 e)g.O•rima(Soccify): ax>3n
<br /> M. MONITORING LOCATIONS 41XH.
<br /> ❑ 1.NLiW Sl1'!;Pt.OT P[.ANJMAP aU13Ml1'TFT)W1TF(T'Hl5 PLAN 2.STTF,PI OT ALAN/MAY PRiLVIOUSi.Y S[JBMIT'I'ED 123CCR42632.26341
<br /> IV. TANK MONITORING IS PERFORMED USING FOLLOWING METHOD(-- thQ `kQii
<br /> I,CONTINUOUS L;LkiCTRONIC TANK MON ITOKING OF ANNIII,AR(IN'rLR!'TYT(A(.)SPACE(S)OR SECONDARY CONTAINMENT VAULT(S)
<br /> WITH AUDIBLE;AND VISUAL ALARMS.123 amt luaz,26341
<br /> aSY,V:.
<br /> SECONDARY CONTAINMENT IS: a DKY U b T,IQiJID FILLED ❑ c.1'RL J`uURV.FIJ ❑ d.UNr,FR VACt1IJM
<br /> avu•Y. MODEL#:
<br /> PANF.I.MANUFACTURER: _�/ G✓� 2!a -
<br /> t✓ n �.,y awr tm MODFT,#(,
<br /> LUAK SENSOR MANIJFAC I'UKCR: �t G !�_[
<br /> _..,....._......_......
<br /> [� 2.AUT'OMA'1'[C TANK GAUGING(AT(i)SYS-1-h-M USED I tJ MUNI I OR SINGLE WALL TAN6(51.Mi CCK Au 44l
<br /> a-xl-1z MODEI,#: a,ati13.
<br /> PANEL MANUFACTURER:
<br /> ax,••1a. aw.rs.
<br /> IN-TANK PTPROBE MANUFAC'i' KELK. MODEL#(S):
<br /> _
<br /> I.F.AK TL'ST IMLIQUENC."'• 4.C;ON'rINUOU3 ❑ b.4)AII.Y/PttCxlt'rLY ❑ c.WEEKLY hx iG.
<br /> ❑ d.MONTHLY
<br /> ❑ c.OTHER(Specify): MXA7.
<br /> avn-Ik.
<br /> $'ROGRAMMED'I'LSTS. a.0.1g.p.h. ❑ b..02 :n:h: ❑ c.OTilBR(S(uci;y):
<br /> _...._ _._. ............_._....._...__... „_ . ._�
<br /> .._. ..-..._ awl-2fb
<br /> ❑ 3.MON IHLY S1AT(ST1CAl.INYFN'CGKY KILCONCIIIATION I.jm.c.xozwi•t1 _
<br /> .............__,._._.._.._...._... _,......._........_.. .... _......
<br /> ❑ 4.WEEKLY MANUAL TANK GAUGING(MTU)123 CC11.(Wil TESTING PERIOD: ❑ a.36 HOURS ❑ b.fiO HO[JKS a+x1-iz
<br /> _.........._..... _.._......_._. ... ---- ---- i,.....
<br /> A V-21
<br /> Q S.TANK INTCGRITY T'F.Tl'IN()PL'K 123CCR IY,4a 11
<br /> 4vu-2a.
<br /> T'1LS'['t'REQUFNCY: U x.ANNUALLY ❑ b.4)IT;NNIAE.l.Y ❑ o.U1HbK(sp%clry_>- 4MI-2s
<br /> .....,...i ..._._..�.,__.-._.....,. . . ._.._...._.................
<br /> -451R-
<br /> .
<br /> ❑ 99,OTHER(Spe ciry):
<br /> V. P1 , MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S)
<br /> that appty
<br /> 1.CONTINUOUS MONITORING OF PIPLIPIPING SUMPS)AND OT'HL''K SECONDARY CONTAINMENT WITI(AUDIBLE&VISUAL AJ,ARMS. -'
<br /> is itFILLED
<br /> a x12y
<br /> Iz<;3G1 SECONDARY CONTAINMENT IS: a.DRY ❑ b.LIQUID Ft1.1.F D �] c.Pf(CSS(fR19.FD ❑ d.UNDER VACUUM
<br /> /t 4� Monn.# �}-fiG p 4xaao
<br /> YANL'L MnN4.IFAC:TIIRElt. !/ �' ��!� / I--�
<br /> ax„r MODEL#(S): � '79y►OI0:'! - avtla3.
<br /> LEAK SENSOR MAN IfF�AC'1'[JRER: D//P ems✓ /'�/�,.
<br /> PIPING LlSAK ALARM TRIGGERS AUTOMATIC PIIMP(i.c.,'t'ilKIiINE)SI[UTL>aWN.
<br /> a.YES ❑ b.NO evoaa
<br /> FAILURC/DI,CONNUC:110N 0["1'411;MOPIrrORING swrliM TRR. s,CMRC AUTOMATIC PUMP 6IIT.ITIM,)WN a YFS ❑ h.NO 4:xl-35
<br /> ❑ 2.MF,CHANICAL LINE.I,RAK DF'fEC'I'OK(MLI,DI l'I EAT ROlJ'1'INELY PL'RfORMS:3.0 g.p.h. LEAK•1'[LS'fS AND RF.STRIC'E'S OR SHUTS OFF
<br /> PRODUCT'Fi,OW WHEN A LEAK IS
<br /> _ I)('1'FCTTD4W-37
<br /> p® 4&1.19
<br /> M[LDMAN[1FAC:fURLR(S): MODEL#(S):
<br /> -
<br /> ❑ 3 F1,RC'!'RUNIC 1.INEi L1LAK I)EA-ECTOK IELLD)THA-I ROk.fTINFI.Y PERFORMS 3.0h.L13AK rrZTS.i=tCe:na-M1Stit
<br /> t;•P•
<br /> q waau' 4%
<br /> HL d(S): u.11.
<br /> Fl.1.D MANUFACt'UKIiIi(S): --
<br /> PROGRAMMED IN LINE:LEAK.TEST: ❑ a.MINIMUM MONTHLY 0.2 g.p.h. ❑ b.MINTMUM ANNUAL 0.1 g.p.h. 4904Z
<br /> ELLD U1iTI:.CT(ON OF A PIPING LEAK TAIC;GFRS AUTOMATIC PtJMP SHU'T'DOWN U a.YES ❑ b.NO
<br /> ELLD FAII,URFJDISCONNGC'I'TON'fR1GC,FRS AUTOMATIC.PUMP SI IU`DOWN. El a.YES ❑ b.NO
<br /> a�xwaa
<br /> _._....___,._..._...._._.
<br /> a�xws.
<br /> [] 4.PIPE INTfLGR.4TY TESTING.
<br /> a!mr 4(
<br /> TEST FRF,QUENCY: ❑ a ANNUALLY ❑ b.EVGRY,. YEARS........ ❑ c•O'1'IICR tSpcc� ) 4ve-47.
<br /> asa0,ae.
<br /> ❑ 1, VISUAI.PIPE.MONITORING.
<br /> FREQUENCY: (,( a.DAILY b.wF.mLY © c.miN..MONTNT.Y,&fAC11 TtmE SYSTEM OPERATED•
<br /> •.lt�v..,.J tl�•mnnenn®ra', ewicd emee�,enur gw�R�Mv imt eap.ng mtl.gn i1RG,;+�,2_ ,lyG,yb.Z(3)
<br /> avu•su.
<br /> ❑ 6.SUCTION PIPING MEETS EXEMPTION CRIT I.TAIA 121('crt Iiz6s6caX211 _......__.........__....___._...
<br /> _._..___...._...�.._..... . ...................................................
<br /> ® 7.NI;)REGULATED PIPING;P1LK R1:A1;rl I AND SAFFTY CODE,DIVISION 20,CHAP )2R 6 71.9 C.ONNF,CTF.D'I'O:I;HL '1'ANiC SY$TF.M. 's'ti'
<br /> p e9,OTI Im(spr TEy) ata ss.
<br /> UPCI±UST-D(12/2007)-1/4 www.unidocs.org
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