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NIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK MONITORING PLAN-(Page 1 of 2) ArR 20 M! TYPE OF ACTION ❑ 1.NEW PLAN ® 2.CHANGE OF INFORMATION 0-9°-1 PLAN TYPE ® 1.MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. 490-2 (Check one item only) ❑ 2.THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM( ENVIRONMENTAL HEALTH I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) I I I - - 1 BUSINESS NAME(Same as FACILITY NAME) Flying J Travel Plaza- #617 3. BUSINESS SITE ADDRESS 15237 N. Thornton Rd " I CITY Lodi 104. II.EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE 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 26.4 .....-_ _..__ --a..._-a....- MONITORING EQUIPMENT IS SERVICED ® 1.ANNUALLY E] 99.OTHER(Specify): _ 490-3b III.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 490-6 -------------___ __---.------------------- PANEL MANUFACTURER: ------PANELMANUFACTURER: Veeder Root 490.1. MODEL#: TLS-350 490-8 _---LEAK SENSOR MANUFACTURER: Veeder Root - - _ -79-0_9 MODEL#(S): 794380-302 490.10 2.AUTOMATIC TANK GAUGING(ATG)SYSTEM USED TO MONITOR SINGLE WALL TANK(S).(23 CCR§2643) 490-11 PANEL MANUFACTURER: 490-12. MODEL#: 490-13 IN-TANK PROBE MANUFACTURER: --�� ago-14. MODEL#(S): 490-15 _- - - - -- --------------------------------------- LEAK TEST FREQUENCY: ❑ a.CONTINUOUS ❑ b.DAILY/NIGHTLY ❑ c.WEEKLY 490-16 ❑ d.MONTHLY ❑ e.OTHER(Specify): 490-17 PROGRAMMED TESTS: ❑ a.0.1 h. ❑ b.0.2 h. c.OTHER(Specify): 490.18 g P g.p.h. ❑ ( P fY) 490-19 ❑ 3.MONTHLY STATISTICAL INVENTORY RECONCILIATION(23 CCR§2646.1): 490-20 ❑ 4.WEEKLY MANUAL TANK GAUGING(MTG)(23 CCR§2645). TESTING PERIOD: Ela.36 HOURS Elb.60 HOURS 490- 21 490-22 2 ❑ 5.TANK INTEGRITY TESTING(23 CCR§2643.1): 490-23 490-24 TEST FREQUENCY: ❑ a.ANNUALLY ❑ b.BIENNIALLY ❑ c.OTHER(Specify): 490-25 ❑99.OTHER (Specify):VISUAL DONE DAILY 490-26 490-27 V.PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(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 PANEL MANUFACTURER: - Veeder Root 490-30 MODEL#: TLS-350 490-31 LEAK SENSOR MANUFACTURER: Veeder Root 490-32 MODEL#(S): 794380-208 490-33 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 CCR263__a _ 490-36 _MMLLD MANUFACTURER(S): FE PETRO,VAPOR-LESS 490-37 MODEL#(S): STD-MLD/LD3000 490-38 ❑ 3.ELECTRONIC LINE LEAK DETECTOR(ELLD)THAT ROUTINELY PERFORMS 3.0 g.p.h.LEAK TESTS (23 CCR§2636) 490.39 ELLD MANUFACTURER(S) 490.40. MODEL#(S): 490-41 PROGRAMMED IN LINE LEAK TEST: ❑ 1.MINIMUM MONTHLY 0.2 g.p.h. ❑ 2.MINIMUM ANNUAL 0.1 g.p.h. 490-42 ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES ❑b.NO 49043 xen''"Z-' ELLD FAILURE/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. ❑a.YES El b.NO ��-=-_ 490-44 4.PIPE INTEGRITY TESTING 490-45 TEST FREQUENCY ❑ a.ANNUALLY ❑ b.EVERY 3 YEARS ❑ c.OTHER(Specify) N/A D/Tpos.shutdown 490-46 49047 ❑ 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 emergency enerator fuel piping only per HSC§25281.5(b)(3 ❑ 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 CONNECTED TO THE TAN SYSTEM 490-51 490-52 ❑ 99.OTHER(Specify) y 490-53 UPCF UST-D(12/2007)