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AS UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN-(Page 1 of 2) 49x1 TYPE OF ACTION ❑1.NEW PLAN 2.CHANGE OF INFORMATION ago-z PLAN TYPE 1.MONITORING IS IDENTICAL FOR ALL USTs AT TIES FACILITY. (Check one item only) ❑ 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S�: I. FACILITY#ORiVIAMON i FACILITY ID#(Agency Use Only) I I I - I - 3. BUSINESS NAME(Same as FACILITY NAME) UROviw$ PA 469 xQ6 R-A fit BUSINESS SITE ADDRESSA rx tvr 103 CITY S Gtw�.1 104 l21 S. S .H.:EQUTPNWNT TESTING AWD PREVENT VE MAINTIENANCE 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) -M 490.30- MONITORING EQUIPMENT IS SERVICED 1.ANNUALLY ❑ 99.OTHER(Specify): 490-3b ::III.MONITORING LOCATIONS I.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 2634)49o-4 I�?TANIIICMO !1 UILTNG, S ',ERF® tiED�USIN(� ftEaTi01 4 A G NW OD(S)i.. 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT ago-s VAULT(S)WITH AUDIBLE AND VISUAL ALARMS. (23 CCR§2632,2634) a9o-6 SECONDARY CONTAINMENT_IS: Of a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED ❑d.UNDER VACUUM _ - -- - -- _ _ --- 490-7. I PANEL MANUFACTURER: V �P't11• -- MODEL#: KI•�S ---- 490-9. i MODEL#(S): a9i1 io LEAK SENSOR MANUFACTURER: V�.�.PFa ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S). 490-11(23 CCR§2643) 490-13 190-12. MODEL PANEL MANUFACTURER: -- - ------------------------ ------- --- _- -- 490-15 IN-TANK PROBE MANUFACTURER: 490-14. 490-15 -_�_-___-_-----__-_- _-_----_-______________________________-________----____ 490-16 LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLT ❑ c.WEEKLY e.OTHER(Specify): a9an ____ ___❑ d.MONTHLY_ ❑ _-------- --------------------------------- _ ---------- 0-90-18 PROGRAMMED TESTS: - ❑ a.0.1 g.p.h - ❑ b.0.2 g.p.h. ❑ c.OTHER(Specify): 490-19 490.20 ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): ago-z1 E] 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§2645). TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS 49x22 490-23 ❑ 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 490-24 TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): 490-25 490-26 ❑99.OTHER (Specify): 490-27 V.,PIPiE:MONLT0,RJ,GhI�a�PERFORIYIEDIUSI'NG OZi�LO ING I)HO�D(ilS)#(Gheak lllthat pply) 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WTTH AUDIBLE AND a90-z8 ISUAL ALARMS. (23 CCR§2636) a.DRY ❑b.LIQUID FILLED _❑c.PRESSURIZED ❑d.UNDER VACUUM 490-31 29 SECONDARY CONTAINMENT IS: _ _ _--- _-_________-__---------. PANEL MANUFACTURER: J iLA tA. I;Lbw" - a9aso MODEL#: ?&.q 0-90-31 490-33 LEAK SENSOR MANUFACTURER: V T 41-32 1 MODEL#(S): Z.v --I-----------_--- - --------- 490-3 PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e. TURBINE)SHUTDOWN. a.YES ❑b.NO 490-355 FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. %a.YES ❑b.NO 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(23 CCR S2636) -__ _-__-____ -------- 490-36 MLLD MANUFACTURER(S): -R Sr& +MIM+fA1t*4'rt t 490-37 �® 490-38 G MODEL#(S): 99 L S) ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS (23 CCR§2636) _-- _490-39 --- - ----`_ � ELLD MANUFACTURER(S) a90ao. MODEL#(S)_ ---------......... ----- ago az PROGRAMMED IN LINE LEAK TEST: ❑ 1.MINIMUM MONTHLY 0.2 g.p.h. ❑ 2.MINIMUM ANNUAL 0.1 g.p.h. ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ❑b.NO 49043 44 ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑ a.YES ❑b.NO ay0 ❑ 4.PIPE INTEGRITY TESTING 49045 TEST FREQUENCY ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(Specify) 490-46490-47 ❑ 5.VISUAL PIPE MONITORING. 490-48 FREQUENCY ❑ a.DAILY ❑ b.WEEKLY ❑c.MIN.MONTHLY&EACH TIME SYSTEM OPERATED- 490-49 "Allowed for monitoring of unburied ernergencu generator fuel pi2ing only per HSC 25281.5(6x3) ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR§2636(a)(3)]. 490-50 ❑ 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS C CTED TO THE TANK SYSTEM 490-51 490-52 99.OTHER(Specify) S O&S R%44CKf_ 1r VU4rJZI 490-53 MAR 2t10P 1 e5 UPCF UST-D(12/2007)1/4 8AfV1R0 R /Ti / L1