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UST Monitoring Plan-Page 1 Instructions
<br /> Complete a separate UST Monitoring Plan for each UST monitoring system at the facility. This form must be submitted with Your initialapproval UST prior Operating
<br /> installing r
<br /> it
<br /> Application and within 30 days of changes in the information it contains. Plastic note that your local agency may require you to obtain app
<br /> modifying monitoring equipment (Note: Numbering of these instructions follows the data element numbers on the form.)
<br /> 490-1. TYPE OF ACTION-Check the appropriate box to indicate why this plan is being submitted
<br /> 490-2. PLAN TYPE-Check the appropriate box to indicate whether this plan covers all,or merely some,of the USTs at the facility. If the plan covers only some Of the tanks,
<br /> identify those tanks in the space provided[e.g.,by using the Tank ID#(s)in item 432 of the UST Operating Permit Application-Tank Information Form(s)l.
<br /> 1. FACILITY ID NUMBER-This space is for agency nae only.
<br /> 3. BUSINESS NAME-Enter the complete Facility Name.
<br /> 103. BUSINESS SITE ADDRESS-Enter the street address where the facility is located,including building number,if applicable.Post office box numbers are not acceptable
<br /> This information must provide a means to locate the facility geographically.
<br /> 104. CITY-Eager the city or unincorporated area in which the facility is located.
<br /> 490-3a MONITORING EQUIPMENT IS SERVICED-Check the appropriate box to specify the frequency of monitoring equipment testing/certification.
<br /> 490-3b Specify Other frequency for monitoring equipment servicing.
<br /> 4904 SITE PIAN-indicate if a site plaminap is submitted with chis monitoring plan or if it was submided previously and is current for the facility,i��� riMonitoring plan most include
<br /> a She Plot Plam&tap showing the tank and piping layouts and the locations where monitoring is performed(i.e.,location of sensors,probes,
<br /> control panel,etc.).
<br /> 490-5 IV-1 CONTINUOUS ELECTRONIC MONffORING-Indicate if this monitoring memod is being used to monitor the tanks.
<br /> 490-6 SECONDARY CONTAINMENT-If IV-1 is checked,check the appropriate box to describe the environment inside the tank secondary containment.
<br /> 490-7 PANEL MANUFACTURER--if IV-1 is checked,enter the name of the manufacturer of the monitoring system control panel(console).
<br /> 49D-8 MODEL#-IfIV-I is checked,enter the model number for the monitoring system control panel.
<br /> 490-9 LEAK SENSOR MANUFACTURER-If IV-1 is checked,enter the name of the manufacturer of the sensor(s).If additional space is needed,use Section X
<br /> 490-10 MODEL#(S)--if IV-1 is checked,enter the model number for each type of sensor installed.If additional space is needed,use Section X_
<br /> 490-11 IV-2 AUTOMATIC TANK GAUGING-Indicate if this method is used for monitoring the UST's.
<br /> 490-12 PANEL MANUFACTURER-If IV-2 is checked,enter the name of the manufacturer of the monitoring system control panel(console).
<br /> 49013 MODEL#-IfIV-2 is checked,atter the model number for the monitoring system control panel.
<br /> 490-14 IN-TANK PROBE MANUFACTURER-If IV-2 is checked,enter the name of the manufacturer of the probe(s).
<br /> 49015 MODEL#(S)-If IV-2 is checked,enter the model number for each type of in-tank probe installed.ifadditional space is needed,use Section X.
<br /> 49016.LEAK TEST FREQUENCY-If IV-2 is checked,check the appropriate box to describe the in-tank leak test frequency.
<br /> 49017.SPECIFY-If 490-16e is checked,enter the frequency of programmed leak rests.
<br /> 490.18.PROGRAMMED TESTS-If IV-2 is checked,check the appropriate box to describe the tests programmed into the ATG system.
<br /> 49019.SPECIFY-If 4901 St is checked,enter the frequency of in-tank leak testing.
<br /> 49020.IV-3 INVENTORY RECONCILIATION-Check the box if statistical inventoryreconciliation is performed.
<br /> 49021.TV-4 WEEKLY MANUAL TANK GAUGING.Indicate if this method is used to monitor the tanks.
<br /> 49022.TESTING PERIOD-if N4 is checked,check the appropriate box to describe the MTG testing period.
<br /> 49023.fV-5 TANK INTEGRITY TESTING:Indicate if this method is used to monitor the tanks.
<br /> 490.24.TEST FREQUENCY-If IV-5 is checked,check the appropriate box to describe the frequency of tank integrity testing.
<br /> 49D-25.OTHER:If 490-24c is checked,specify other test frequency.
<br /> 49026.IV-99 OTHER:Indicate if monitoring of the tanks occurs that is not indicated in any other category.
<br /> 490-27.If IV-99 is checked,enter a brief description of the other tank monitoring methods)used(e.g.,vadose zone monitoring per 23 CCR§2647,groundwater monitoring per
<br /> 23CCR§2648). Include the monitoring frequency,(e.g.,Continuous,Weekly). If additional space is needed,use Section X.
<br /> 490-28. V-1 CONTINUOUS MONITORING OF PIPEIPIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIB LE AND VISUAL ALARMS:
<br /> Indicate if this is the monitoring method used for the piping.
<br /> 490-29.SECONDARY CONTAINMENT:If V-1 is checked,Check the appropriate box to describe the environment inside piping secondary containment.
<br /> 49030.PANEL MANUFACTURER-If V-1 is checked,enter the name of the manufacturer of the monitoring system control panel(console).
<br /> 49031.MODEL#-If V-1 is checked,enter the model number for the monitoring system comrol panel.
<br /> 49032.LEAK SENSOR MANUFACTURER-If V-1 is checked,enter the time of the manufacturer of the,019011(s)
<br /> 49033.MODEL#(S)-If V-1 is checked,enter the model number for each type of sensor installed.If additional space is needed,use Section X.
<br /> 49034.PIPING LEAK ALARM T RIGGERS AUTOMATIC PUMP SHUTDOWN -If V-1 is checked,check Yes or No.
<br /> 49035.FAD.UR&DLSCONNEC RON OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN-If V-1 is checked,check Yes or No.
<br /> 49036.V-2 PIPE MECHANICAL LINE LEAK DETECTORS PERFORM 3 GPH LEAK TESTS:Indicated this monitoring method is used to monitor the pipelines.
<br /> 490-37.MLLD MANUFACTURER(S)-If V-2 is checked,enter the name(s)of the manufacturer(s)of the mechanical line leak detector(s).if additional space is needed,use
<br /> Section X
<br /> 490-39.MODEL#(s)-If V-2 is checked,Enter the model number for each type of mechanical line leak detector installed.if additional space is needed,use Section X.
<br /> 49039.V-3 PIPE ELECTRONIC LINE LEAK DEFECTORS:Indicate if this monitoring method mused to monitor the pipelines-
<br /> 49040.El.1 MANUFACTURER-If V-3 is checked,Enter the name of the manufacturer of the electronic line leak detecau(s).
<br /> 49041.MODEL#(S)n- If V-3 is checked,enter the model number for each type of electronic line leak detector installed.If additional space is needed,use Section X.
<br /> 49042.PROGRAMMED LINE INTEGRITY TESTS-If V-3 is checked,check the appropriate box to describe the type of tests programmed into the monitoring system.
<br /> 49043.ELLD DETECTION OF A PIPING LEAK ALARM TRIGGERS PUMP SHUTDOWN-If V-1 is checked,check Yes or No.
<br /> 49044.EI.LD DETECTION OF A PIPING LEAK FAB.UREIDISCONNECTION TRIGGERS PUMP SHUTDOWN.-If V-1 is checked,check Yes or No.
<br /> 49045.V4 PIPE INTEGRITY TESTING-Indicate if this monitoring method is used to monitor the pipelines.
<br /> 490-46.TEST FREQUENCY-If V4 is checked,check the appropnaw box to describe the frequency of pipe integrity testing.
<br /> 49047.SPECIFY-If 4904699 is checked,enter the frequency of pipe integrity testing.
<br /> 490-48.V-5 VISUAL PIPE MONITORING- Indicate if this monitoring method is used to monitor the pipelines.
<br /> 49049.If V-5 is checked,check the appropriate box to describe the frequency of visual monitoring.
<br /> 49050.SUCTION PIPING MEETS EXEMPTION CRITERIA- indicate if this monitoring method is used to monitor the pipelines.
<br /> 490.51.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM- Check this box if an
<br /> piping in the tank system is regulated under the UST law,or there is no piping.
<br /> 49052.V-99 OTHER-Indicate if another method is used for pipeline monitoring.
<br /> 49053.SPECIFY-Enter a brief description of the other line monitoring method(s)used. If additional space is needed,see Section X Be sure to clearly describe
<br /> monitoring methods)and frequency.
<br /> This monitoring plan must include a Site Plan showing the general tank and piping layouts and the locations where monitoring is performed(i.e,location of each sensor,line leak
<br /> detector,monitoring system control panel,etc.). If you already have a diagram(e.g.,current UST Monitoring Site Plan from a Monitoring System Certification form,Hazordous
<br /> Materials Business Plan map,etc.)that shows all required information,include it with this plan.
<br /> UPCF UST-D({212007)214
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