COMPLIANCE INFO_2007- 2008 - Laserfiche WebLink

Home Browse Search

06/11/2008 WED 8: 15 FAX 2094683433 SJC EHD 14004/007 • • • (Agency Use Orly) This plan h .be reviewed and: , lb7pproved ❑Approved With Conditions ' Local Agency Signature: � �iG• Date: -ZZ' Comments or Special Condifions: ` UST Monitoring Plan—Page 2 Instructions Complete a separate UST Monitoring Plan for each UST monitoring system at the facility. This form must be submitted with your initial UST Operating Permit Application and within 30 days of changes in the information it contains. Please note that your local agency may require you to obtain approval ViLQr to installing or modifying monitoring equipment. (Note: Numbering of these instructions follows the data element numbers on the form.) 490-54L MONITORING OF THE UNDER DISPENSER CONTAINMENT-indicate the method used for UDC monitoring. 490-54b.SPECIFY-If 99"Other"is clinked,describe other method wed. If VI-I-1,VI-1-2 or VI-1-3 or VI.1.99 is checked.complete 490-55 to 490.646. 490.55. PANEL MANUFACTURER-Enter the were of the manufacturer of the monitoring System control panel(console). If there is no control panel(e.g.,only an electrical relay box is installed)leave this space blank. 490-56. MODEL II- Enter the model number for the monitoring system control panel(console).If there is no control panel(e.g.,only an electrical relay box is installed)leave this space blank. 490.57. LEAK SENSOR MANUFACTURER-Enter the name of the manufacturer ofthe smsor(s). 490-58. MODEL M(S)-Enter the model number of the semor(s)installed.If additional space is needed,use Section X. 490-59. DETECTION OF A LEAK INFO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. Indicate Yes or No 490.60, UDC LEAK ALARMTRIGGERS PUMP SHUTDOWN- Indicate Yoor No 490-61. FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PI1tvIP SHUTDOWN-Indicate Yes or No 490-62. UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER-Indicate Yes or No. 490.63. UDC CONSTRUCTION- Indicate if the cowtnrction of this UDC is single-walled,or clmblewdled. 490.64a DOUBLE-WALLED INTERSTITIAL SPACE MONITORING- Indicate what 4 wed to monitor the interstitial space. • 490-646.LEAK WITHIN THE SECONDARY CONTA@4ENT OF UDC TRIGGERS AUDIBLE AND VISUAL ALARMS-Indicate Yes or No 490-65. VII-I ELD TESTING-Check the box ifyou have been notified by the State Water Resources Control Board(SWRCB)that the UST(s)covered by this plan is/are subject to Enhanced Leak Detection Requirements(i.e.,UST has any single-wall component and is located within 1,000 feet of a public drinking water well). 490.66. TESTING OF SECONDARY CONTAINMENT COMPONENTS EVERY 36 MONTHS-Check the box If you have secondary containment that requires toting. 490-67. SPILL BUCKET TESTING-Check the box if you have spill buckets. 490-68a-h.VIII RECORDKEEPING-Indicate which monitoring and equipment maintenance records are maintained for thi3 flaini ty. 490-69a IX TRAINING STATEMENT-Check the box to verify that the statement is me REFERENCE DOCUMENTS MAINTAINED AT FACILITY-Check the appropriate boxes to describe reference documents maintained at the facility. Notethatthe fust two items on the list m9a be kept at the facility. 490-69b. MONITORING PLAN:Indicate that this plan is kept as a reference document. 490-690. OPERATING MANUALS FOR ELECTRONIC EQUIPMENT:Indicate the this plan is kept w a reference document. 490.69d. CA UST REGULATIONS-Indicate that this is kept as a reference document. 490-69e. CA UST LAW-Indicate that this is kept as a reference document. 490-69£.STATE WATER RESOURCES CONTROL BOARD(S WRCB)PUBLICATION- "HANDBOOK FOR TANK OWNERS-MANUAL AND STATISTICAL INVENTORY RECONCILIATION-Indicate that this is kept as a reference document. 490-69g.S WRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS".Indicate that this is kept as a reference document. 490-69h.OTHER-Indicate that other reference documents are kept 490.69i. SPECIrY-If"OTHER"is checked,enters brief description of the other document(s)maintained at the facility.If additional space is needed,see Section X. 490-70. DESIGNATED OPERATOR TRAINING-Check this box to verify that this statement is true. 490-71. COMMENTS/ADDITIONAL INFORMATION-Make additional comments or you may attach and identity the number of additional pages of information to describe any additional UST system monitoring-related information(e.g.,additional information required by your local agency). Attach any monitoring logs Oxr you will be wing for the monitoring ofyour tank system. 490.72. NAME-Enter the name of the person who routinely conducts the monitoring and equipment maintenance under this plan. 490-73. TITLE- Enter the title of the person. 490-74. NAME-Enter the name of the second person,if applicable,who routinely conducts the monitoring and equipment maintenance under this plan. 49045. TITLE- Enter the tills of the second person. OWNEWOPERATOR SIGNATURE-The tank owner/operator,facility owner/operator,or an authorized representative of the owner shall sign in the space provided. This signature milifies that the signer believes that all information submitted is true,accurate,and complete,and that the training program specified in Swim IX has been implemented, 490-76. REPRESENTING--Check the appropriate box to indicate whether the signer is the UST owner/operator,the UST facility owner/operator,or at authorized representative of fix owner. 490.77. DATE-Enter the date the plan was signed. 490.78. APPLICANT NAME-Print or type the name,of the person signing the plan. 490-79. APPLICANT TITLE-Enter the tide of the person signing the plan. • UPCF UST-D(12/2007)4/4