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UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN- Pae I of 2 TYPE OF ACTION ❑1.NEW PLAN ® 2.CHANGE OF INFORMATION ' PLAN TYPE ® 1.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. 2 490-z (Check one item only) ❑ 2,THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTCM( `• L FACILITYINFORMATION some FFA a I lab FACILITY ID#(Agency Use Only) - Nv Ne FE r _ ............ ____ _...__ _............:.........._..... BUSINESS NAME(Same as FACILITY NAME) Flying J Travel Plaza #617 -...._....... ...._................. i _ BUSINESS SITE ADDRESS 15237 N.Thornton Rd 107' crrY Lodi 104" IL EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE -resting,preventive maintenance,and calibration of monitoring equipment(e.g.,sensors,probes,line leak detectors,etc.)must be performcd 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 2632.26342638 2641 MONITORING EQUIPMENT IS SERVICED ® 1.ANNUALLY C199,OTHER(Specify): 490-3b ICI MONITORING LOCATIONS - ®1.NEW SITE PLOT PLAN/MAP SUBMITTED WITH THIS PLAN. ❑2.SITE PLOT PLAN/MAP PREVIOUSLY SUBMITTED. (23 CCR§2632, 2634)490=4 _ IV.TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): 1.CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR(INTERSTITIAL)SPACE(S)OR SECONDARY CONTAINMENT 490-5 VAULT(S)WITH AUDIBLE AND VISUAL ALARMS. (23 CCR§2632,2634) SECONDARY CONTAINMENT IS: ❑ a.DRY ® b.LIQUID FILLED ❑ c.PRESSURIZED ❑d.UNDER VACUUM °90-6 __......_..__ .. ___.__ ._.._.._-___ _ �. ---------- PANEL MANUFACTURER: Veeder Root 490 7, MODEL#: TLS 350 40 LEAK SENSOR MANUFACTURER: Veeder Root 9` MODEL#(S); 794380-302 490-ro 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR MINGLE WALL ANK($).(23 CCR§2643) PANEL MANUFACTURER: 4912` MODEL#: 490-13 IN-TANK PROBE MANUFACTURER: 490-14- MODEL#(S). H Oso is' LEAKIEST FREQUENCY: El a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY 4916 ❑ d.MONTHLY ❑ e,OTHER(Specify) 490-17 ». 490.18 PROGRAMMED TESTS: ❑ a.0.1 g.p.h. ❑ b.0.2 g.p.h. ❑ e.OTHER(Specify): 490.19 ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 490.20 ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§2645). TESTING PERIOD: ❑ a.36 HOURS ❑ b.60 HOURS 490. 22 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 4923 4900-24 TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): 490-25 49°-26 ❑99.OTHER (Specify);VISUAL DONE DAILY 490-27 V.PIPE MONITORING IS PERFORMED USING THE FOLLOWING METROU(S)(Check all that apply) 1.CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE.AND 490.28 VISUAL ALARMS. (23 CCR§2636) SECONDARY CONTAINMENT IS:®a.DRY ❑b.LIQUID FILLED ❑c.PRESSURIZED ❑d.UNDER VACUUM 490 29 -_-._...-_-._.--._._ __ u._..._ _H._._. _ _ _v _ � � � �_ __..__ ._------ ---- PANEL MANUFACTURER: Veeder Root 490-30 MODEL#: TLS-350 490-31 -_-__-._,.__-..__.................. ._._._._.� __ _._.�_......w� ___ _._.....-._-. .. __.._._ ._. ._...--_.._ w.__._.............__. __._..._.._..._.... 490.32 MODEL#(S): T1-#794380-322 490-33 LEAK SENSOR MANUFACTURER: Veeder Root 'I'2 T3 T4,T5-#794380-352 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 PRODUCT FLOW WHEN A LEAK IS DETECTED(23 Cgg 2636_- r _. - v_ _. _. _.._.._.._.. 490-36 MLLD MANUFACTUPXR(S): FE PETRO,VAPORLESS 490-37 MODEL#(S); STD-MLD/LD3000 490-3 ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS (23 CCR§2636) _ _ 490-39 - .ELLD MANUFACTURER(S) # � - »�490-4o_ MODEL#(S} �TM« -�49041 DDEL _.._ PROGRAMMED IN LINE LEAK TEST: ❑ 1.MINIMUM MONTHLY 0.2 g.p.h. ❑ 2.MINIMUM ANNUAL 0.1 g.p.h. 49°42 ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 49043 ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 49044 4.PIPE INTEGRITY TESTING 440-4s TEST FREQUENCY ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ e.OTHER(Specify) N/A D/Tpos.shutdoWn 49046 49047 5,VISUAL PIPE MONrrORING. 490-48 FREQUENCY ❑ a.DAILY ❑ b.WEEKLY ❑c,MIN.MONTHLY&EACH TIME SYSTEM OPERATED° 49049 •Allowed for monitorinA ofunburied emer enc nerator fuel&ina only ger HSC 125281,5(b)(3 ❑ 6.SUCTION PIPING MEETS EXEMPTION CRITERIA[23 CCR§2636(a)(3)). 490-50 7.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM 49°•51 ❑ 99.OTHER(Specify) 490-52 490.53 UPCF UST-D(12/2007)