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AMWNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANK <br /> MONITORING PLAN-(Page 1 of 2) <br /> TYPE OF ACTION ❑1.NEW PLAN 2.CHANGE OF INFORMATION 490-1 <br /> PLAN TYPE ]g 1.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. 490.2 <br /> (Check one item only) ❑ 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S)- <br /> I. FACILITY INFORMATION <br /> FACILITY ID#(Agency Use Only) - 1 <br /> BUSINESS NAME(Same as FACILITY NAME) 1 / / L 3' <br /> BUSINESS SITE ADDRESS R&!Vf� Coles a- w 10' CITY M,&,V pCA 104 <br /> CA <br /> H.EQUIPMENT TESTING ANIS PREVENTIVE MAINTENANCE <br /> Testing,preventive maintenance,and calibration of monitoring equipment(e.g.,sensors,probes,line leak detectors,etc.)must be performed at the frequency <br /> specified by the equipment manufacturers'instructions,or annually,whichever is more frequent,and that such work must be performed by qualified personnel. <br /> (23 CCR§2632,2634,26382641 _ w <br /> MONITORING EQUIPMENT IS SERVICED 1.ANNUALLY ❑ 99.OTHER(Specify): 490-38 <br /> Q � 490-36 <br /> III.MONITORING LOCATIONS <br /> ❑1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. [a 2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, <br /> 2634)490.4 <br /> IV.TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): <br /> 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT 490.5 <br /> VAULT(S)WITH AUDIBLE AND VISUAL ALARMS. (23 CCR§2632,2634) <br /> SECONDARY CONTAINMENT IS: ® a.DRY ❑ b.LIQUID FILLED ❑ c.PRESSURIZED ❑d.UNDER VACUUM 490-6 <br /> PANEL MANUFACTURER: �k -'-�J ^ 490-7• i MODEL#: 490-8 <br /> LEAK SENSOR MANUFACTURER: P 490-9. i MODEL#(S): �?�Z 49010 <br /> ❑ 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(SI.(23 CCR§16-43) 49D-11 <br /> PANEL MANUFACTURER: 490-12. MODEL#: 490-13 <br /> IN-TANK PROBE MANUFACTURER: 490-14. MODEL#(S): -� 490-15 <br /> LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY 490.16 <br /> -- - <br /> EI'd.MONTHLY -_-- - ❑ e.OTHER(Specify): -- --_----- 49047 <br /> PROGRAMMED TESTS: ❑ a.0.1 h. ❑ b.0.2 h. ❑ c.OTHERS eci <br /> 490-ii- <br /> PROGRAMMED g•P� (Specify): 490-19 <br /> ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 490-20 <br /> ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§2645). TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS 490-21 <br /> 90 22 <br /> ❑ 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 490-23 <br /> TEST FREQUENCY: a.ANNUALLY b.BIENNIALLY ❑ c.OTHERS eci 49D 2a <br /> Q ❑ ❑ (Specify): 490-25 <br /> C]99.OTHER (Specify): 490-26 <br /> 490.27 <br /> V.PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S)(Check all that apply) <br /> ❑1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND 49028 <br /> VISUAL ALARMS. (23 CCR§2636) <br /> SECONDARY CONTAINMENT IS:❑a.DRY ❑b.LIQUID FILLED [3c.PRESSURIZED ❑d.UNDER VACUUM 490-29 <br /> PANEL MANUFACTURER: 490-30 1 MODEL#' 490-31 <br /> LEAK SENSOR MANUFACTURER: 49°-32 1 MODEL#(S): -`_-__ 490-33 <br /> PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP(i.e.,TURBINE)SHUTDOWN. - ❑a.YES ❑b.NO 490-34 <br /> FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 490-35 <br /> ❑ 2.MECHANICAL LINE LEAK DETECTOR(M LD)THAT ROUTINELY PERFORMS 3.0 g.p.h LEAK TESTS AND RESTRICTS OR SHUTS OFF <br /> PRODUCT FLOW WHEN A LEAK IS DETECTED 23 CCR 2636 490-36 <br /> MLLD MANUFACTURER(S): 490-37 MODEL#(S): 490-38 <br /> ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS (23 CCR§2636) ---- 490-39 <br /> ELLD MANUFACTURER(S) 4910' i MODEL#(S):- - 490-41 <br /> PROGRAMMED IN LINE LEAK TEST: ❑ 1.MINIMUM MONTHLY 0.2 g.p.h. ❑ 2.MINIMUM ANNUAL 0.1 g.p.h. 49042 <br /> ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 49043 <br /> ELLD FAILURE/DISCONNECTTON TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 4904 <br /> ❑ 4.PIPE INTEGRITY TESTING 49045 <br /> TEST FREQUENCY ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(Specify) 4904649047 <br /> ❑ 5.VISUAL PIPE MONITORING. 490-48 <br /> FREQUENCY Ij a.DAILY ❑ b.WEEKLY ❑c.MIN.MONTHLY&EACH TIME SYSTEM OPERATED* 49049 <br /> 'Allowed for monitoring of unburied entergency generator f=1 pipingonly pa HSC§25281.5(b)(3) <br /> 6.SUCTION PIPING MEETS EXEMPTION CRITERIA[23 CCR§2636(a)(3)l. 490-50 <br /> ❑ 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM <br /> 490-61 <br /> C] 99.OTHER(Specify) 490-52 <br /> 490-53 <br /> UPCF UST-D(1212007)1/4 <br />