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UNIFIM PROGRAM CONSOLIDATED FORM
<br /> UNDERGROUND STORAGE'I'ANK
<br /> MONITORING PLAN-Ea&e I of 2
<br /> a'xl-e.
<br /> TYPE OF ACTION ❑ 1,NEW PLAN Z 2.CHANGE Or INFORMATION
<br /> PLAN TYPL I.MON70RINC IS IDF'NTICAL FOR ALL,USTs AT TIPS FACILITY.
<br /> (Check one item only) [] 2.THIS PLAN COVFRS ONLY THE FOLLOWING LIST SYS'I'ECM(S):
<br /> I. FACILITY INFORMATION
<br /> FACII.rrY ID M(rlgenncv Vic UnOI - -
<br /> 3.
<br /> BUSINESS NAME(Same as facility Name or D8A1
<br /> ios4Cl ! ! baa.
<br /> BUSINESS SITE ADDRESS
<br /> �°
<br /> II. EQUOMENT TES'T'ING AND PREVENTIVE: MAINTENANCE
<br /> Testing,preventive muinlettance,and calibration of monitoring equipnxmt(e.g.,sensors,probes,lige leak,dates-tors,etc.)must be performed at the liaqucngy specified
<br /> by tate ipmant manufaetarers i(uuuetiowi or annually,whichever is more frequent.Such work must foM%Cd„b ualifiio rsonncl.Iza q§26n.ups,ZWS,26411
<br /> rens.__ _a _.. Y.... __,._.. n3_..,_. ._. PC!.- ._g.,__........ PC'..._,_._,.--__.....' dxr3a
<br /> MONITORING RQUIPMEN'f IS SF.RVIC1 0 I.ANNUALLY ❑ 49.OTHER(Specify) 4%0b.
<br /> III.
<br /> MONITORING LOCATIONS
<br /> ® arra.
<br /> 1.NEW SITE PLOT PLAN/MAP SUBMITTED WL'l'H'fIIIS PLAN A 2.SITE PLC}'1'PLAN/MAP PREVIOUSLY SUBMfIT ED lz:(;cR 1263t 26341
<br /> I'V'. TANK MONITORING IS PERFORMED USING THE]FOLLOWING METHOD( / that a S au
<br /> thata fy
<br /> 1.CONTINUOUS EL,F,CTRUNIC'TANK MON II'ORING OP ANNULAR(INTERSTITIAL)SPACF(S)OR SECONDARY CONTAINMENT VAUL'C(S) a<w'3.
<br /> WITH AUDIBLE AND VISUAL ALARMS.lz3CCR§W32.26341 44n 6
<br /> SECONDARY CONTAINMENT IS: a•DRY ❑ b Livulu PILLED [2 c.PPL23SURIZED ❑ d.UNDLILVACUUM
<br /> dwr. MODEL/J- L �s �!r® 4'x4
<br /> PANEL MANUFACTUREK: 60 -
<br /> 490-9. #(S): 490-10.
<br /> _ LEAK SENSOR MANUFA('T_UF.R
<br /> _R : �� A8 fMODEL.. -
<br /> -❑2,AUTOMATIC TANK UAUUING(ATCz)SYSTLM USED TO MONUOR S1NG1.0 WA1j,TANK(S).;n M%824"1 � 4�- 490-
<br /> d"ar12. MODEL 4:
<br /> PANEL.MANLIFAC''CURFR: -
<br /> 493-td. MODEL#(S): 4!X)-l5
<br /> IN-TANK PROBEMANtJFAC RHR;
<br /> (
<br /> LCAIv TEST FKLQUCNCY: U.CONTINUOUS [I1)
<br /> b. AII.Y/NICIMTI.Y I l C.WEFKLY 4%46.
<br /> aw•17.
<br /> ❑ d.MONTHLY ❑ c,OTHER(Specify):
<br /> PROGRAMMED TESTS' - Q c._C®CtIE_R._.(Specify):..
<br /> F _ . ....... .
<br /> 490-20
<br /> ❑ S.MONTIiLY STATISTICAL,INVEN'l'UKY 1+,I'(.'ONCILIA'1'10N Ia)CCe fWA6.I I ............. _ �.�,. ,,,,,,,, _, ,,, __
<br /> [� 4.WfrGKLYMANIJAL'fANKCiA.IJGiN'G(MTG)123('(rRt26431 I'ES't'lNGPF.RIOD: ^❑ a.3F)10URS ❑ b.60HOURS T .._. 491.22
<br /> [� 5.TANK INTEGRITY TESTING PER 123 UR 02643.11
<br /> ax424.
<br /> TEST FREQ.._......,,I NC.._..._.'Y: .❑a .ANNUALLY._-'® b.BIENNIALLY-y 0 c OTiiLlt(S ecifO:
<br /> ....._....._._._....._,_... .� ._._. 4X1,26.
<br /> E] 99.OTHER(Spe:city): ahck
<br /> V. PIPE MONITORING IS PERFORMED USING TRE FOLLOWING METHOD(S) aal k 111
<br /> 1.CONTINUOUS MONITORING OF PIPEIPIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE&VISUAL ALARMS.
<br /> 1 Com& SECONDARY CONTAINMENT IS: �,a D`RY ❑ b.LIQUID FILLED ❑ c,PRESSURIZED ❑ d.UNDER VACUUM °xI'zv'
<br /> �PiQ�+' 1�.t7f� _ 44(a-sn. MODEL#: fi` V avu-s 1.
<br /> PANF1,MANUI�ACT'IJRP.R: �--^ --
<br /> AW-12.. MODEL#(S):
<br /> LEAK SUNSOR MANUFACrUKFR: D//A
<br /> de✓ Iia/� � o-„- 4vo-33.
<br /> O
<br /> PIPING LEAK ALARM't'KEGGFRS AUTOMATIC PUMP(i.e.,TURI3INF)SHUTDOWN. a.YES [3h.NO 41H'j4'
<br /> FAILURE/DI3C0NNRrTI0N 01`141F MONITORING SYSTEM TRIGCISRS AUTOMATIC•PUMP SHUTDOWN. a.YES ❑ b,No
<br /> 4eu•15.
<br /> 2.MEC.HAN(CAL LINE LEAK DFTF.C1'OR(MLLD)THAT ROUTINEI:Y PERFOKMS 3.0 g.p.h.LEAK TESTS AND RESTRICTS OR SHUT
<br /> S OR
<br /> PRODUCT FLOW WHEN A LEAK 1S()FFTFCTED. 23 CCR§2fixI
<br /> _ _ _ h�L+ - 4%47 MODEL�!(S: 7 7
<br /> MLLU MANUFACTURER S): !�' C �_..._.__ .
<br /> ' -I9U-39.
<br /> ❑ 3.ELECTRONIC:LINE LEAK DETECTOR(El.1.b)THAT ROUTINELY rI-XF0KMh 3.V g.p.h.(,[-,AN TESTS.1�3 t ie<gzb" ahn 41
<br /> ELLD MANIJFAt 1 URLR(S) 41M-ft MODEL#(S).-
<br /> axeaz.
<br /> PROGRAMMED IN LINE LEAK TEST: ❑ a.MINIMUM MONTHLY 0.2 g.p.h. ❑ b.MINIMUM ANNUAL.0.1 g.p.h.
<br /> @LLD DFTFC'TION OF A PIPING LEAK'fRIGGFRS AUTOMATIC PUMr SHU 1 uuWN. Q n.Yes ❑ b•Na 490-4)•
<br /> FLLD FAILURE/DISCONNECHON TRIGGERS AU'T'OMATIC PUMP SHUI'LN)WN. ❑ a,YFS Cl b.NO
<br /> © 4,PIPE INTEGRITY'TESTING.
<br /> d911-t6.
<br /> .TEST FRFQUENCY:� -,Q ;L ANNUALLY Q b.LVERY:3 YFARS ❑ c.U'rlWX(Specifyf 490-47.
<br /> 490.4E.
<br /> ❑ 5.VISUAL.PIPE MONITORING.
<br /> FREQUENCY; ❑ a.DAILY h.WEEKLY ❑ C.MIN.MONTHLY a EACII TIMI',SYSTEM OPERATED'
<br /> 14110% fsR. tm--N-rm"W COA 02208 onto#5q.11 5'N 1.?C-.1L3.1. .. .
<br /> ❑ 6.SUCTION PIPING MF.FTS EXEMPTION CRITERIA.123 CCR 42R)4t434
<br /> © 7.NO REGULATED PIPING PER I IFALTH AND SAIL:I'Y CODF,DIVISION 20,CI IAPTFR 6.7 IS CONNEC-TED TO THE TANK SYSTEM.
<br /> ❑ 99.a'r)iBR awl.s3.
<br /> UPCF UST-D(12/20137)-1/4 www.unidoes.org
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