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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 initial UST Operating Permit
<br /> Application and within 30 days of changes in the information it contains. Please note that your local agency may require you to obtain approval mfior to installing or
<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,ofthe USTs at the facility. If the plan covers only some ofthe tanks,
<br /> identify those tanks in the space provided[e.g.,by using the Tank ID 8(s)in item 432 ofthe UST Operating Permit Application-Tank Information portals)].
<br /> I. FACILITY ID NUMBER-This space is for agency use only.
<br /> 3. BUSINESS NAME-Enter the complete Facility Name,
<br /> 103. BUSINESS SITE ADDRESS-Emu the street address where the facility is located,including building number,ifapplicable.Post office box numbers are not acceptable
<br /> This information muss provide a means to locate the facility geographically.
<br /> 104. CITY-Enter the city or unincorporated Brea 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 /> 490-4 SITE PLAN-Indicate if a site plarimap is submitted with this monitoring plan or if it was submitted previously and is current for the facility.Monitoring plans must include
<br /> a Site Plot PladMap showing the tank and piping layouts and the locations where monitoring is performed(i.e.,location ofsemms,probes,line leak detectors,monitoring system
<br /> control panel,etc.).
<br /> 490-5 TV- CONTINUOUS ELECTRONIC MONITORING-Indicate if this monitoring method is being used to monitor the tanks.
<br /> 490-6 SECONDARY CONTAINMENT-If IV-1 is checked,check the appropriate box to describe the emimmr ent inside the tank secondary containment.
<br /> 490-7 PANEL MANUFACTURER--If IV-1 is thicked,enter the name of the manufacturer ofthe monitoring system control panel(console).
<br /> 490.8 MODEL k-IfIV-1 is checked,enter the model number for the tnomtoring system control panel.
<br /> 4904 LEAK SENSOR MANUFACTURER-IfIV-1 is checked,enter the name ofthe manufacturer ofthe sensm(s).If additional space is needed,nae Section X.
<br /> 490-10 MODEL 8(S)--IfIV-1 is checked,enter the model number for each type of sensor installed.If additional space is needed,ase Section X.
<br /> 490-11 IV-2 AUTOMATIC TANK GAUGING-Indicate ifthis method is used for monitoring the UST's.
<br /> 490.12 PANEL MANUFACTURER-IfIV-2 is checked,enter the name ofthe manufacturer ofthe monitoring system control panel(console).
<br /> 49413 MODEL 8-IfIV-2 is checked,enter 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 ofthe probe(s).
<br /> 490-15 MODEL 8(S)-If IV-2 is checked,enter the model number for each type of in-tank probe installed.If additional space is needed,use Section X.
<br /> 49416.LEAK TEST FREQUENCY-I17IV-2 is checked,check the appropriate box to describe the in-tank leak test frequency.
<br /> 49417.SPECIFY-1174941he is checked,enter the frequency of programmed leak tests.
<br /> 49418.PROGRAMMED TESTS-If IV-2 is checked,check the appropriate box to describe the tests programmed into the ATG system.
<br /> 49419.SPECIFY-If 4941St is checked,enter the frequency of in-tank leak testing.
<br /> 490-20.IV-3 INVENTORY RECONCILIATION-Check the box ifsmtistical inventoryreconciliationispmfomed.
<br /> 49421.N-0 WEEKLY MANUAL TANK GAUGING.Indicate ifthis method is used to monitor the tanks.
<br /> 49422.TESTING PERIOD-IfIV4 is checked,check the appropriate box to describe the MTG testing period-
<br /> 4W23.
<br /> eriod49473.IV-5 TANK INTEGRITY TESTING:Indicate ifthis method is used to monitor the tanks.
<br /> 490.24.TEST FREQUENCY-IfIV-5 is checked check the appropriate box to describe the frequency of tank integrity testing.
<br /> 49425.OTHER:If490-24c is checked,specify other test frequency.
<br /> 490-26.IV-99 OTHER:Indicate if monitoring ofthe tanks occurs that is not indicated in any other category.
<br /> 49427.IfIV-99 is checked,enter a brief description of the other tank monitoring meflus )used(a.g.,vadme zone monitoring per 23 CCR§2647,g,nundwmtt monitoring per
<br /> 23CCR§2648). Include the monitoring frequency(e.g.,Continuous,Weekly). If additional space is needed,use Section X.
<br /> 49428. V-1 CONTINUOUS MONITORING OF PEE/PIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIB LE AND VISUAL ALARMS:
<br /> Indicate ifthis is the monitoring method used for the piping.
<br /> 49429.SECONDARY CONTAINMENT:IfV-1 is checked,Check the appropriate box to describe the environment inside piping secondary containment.
<br /> 49430.PANEL MANUFACTURER-IfV-1 is checked,enter the name ofthe manufacturer ofthe monitoring system control panel(console).
<br /> 49431.MODEL k-I1TV-1 is checked,enter the model number for the monitoring system control panel.
<br /> 490-32.LEAK SENSOR MANUFACTURER-If V-1 is checked,enter the name of the manufacturer ofthe sensor(s).
<br /> 49433.MODEL 8(S)-If V-I is checked,enter the model number for each type ofsensor installed.If additional space is needed,use Section X.
<br /> 49434.PIPING LEAK ALARM T RIGGERS AUTOMATIC PUMP SHUTDOWN-If V-1 is checked,check Yes or No.
<br /> 49435.FAILUREIDISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN-If V-1 is checked,check Yes or No.
<br /> 49436.V-2 PIPE MECHANICAL LINE LEAK DETECTORS PERFORM 3 GPH LEAK TESTS:Indicate ifthis monitoring method is used to monitor the pipelines.
<br /> 49437.MLLD MANUFACTURER(S)-If V-2 is checked,enter the tnune(s)ofthe manufueturer(s)ofthe mechanical line leak detemor(s).Ifadditional space is needed,use
<br /> Section X.
<br /> 49438.MODEL 0(s)-If V-2 is checked,Enter the model number for each type of mechanical line leak detector installed ff additional space is needed,use Section X.
<br /> 49439.V-3 PIPE ELECTRONIC LINE LEAK DETECTORS:Indicate ifthis monitoring method is used to monitor the pipelines.
<br /> 490-40.ELLD MANUFACTURER-IfV-3 is checked.Enter the name ofthe manufacturer ofthe electronic line leak detemor(s).
<br /> 490-41.MODEL#(S)n- IfV-3 is checked,emer 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-IfV-3 is checked,check the appropriate box to describe the type uftests programmed into the monitoring system.
<br /> 49043.ELLD DETECTION OF A PIPING LEAK ALARM TRIGGERS PUMP SHUTDOWN-IfV-1 is checked,check Yes or No.
<br /> 490-44.ELLD DETECTION OF A PIPING LEAK FAILUREIDISCONNECTION TRIGGERS PUMP SHUTDOWN.-IfV-1 is checked,check Yes or No.
<br /> 49045.V-4 PIPE INTEGRITY TESTING-Indicate ifthis monitoring method is used to monitor the pipelines.
<br /> 490.46.TEST FREQUENCY-If V-4 is checked,check the appropriate box to describe the frequency of pipe integrity testing.
<br /> 490-47.SPECIFY-If490-46-99 is checked,enter the frequency of pipe integrity testing.
<br /> 490.48.V-5 VISUAL PIPE MONITORING- Indicate ifthis monitoring method is used to monitor the pipelines.
<br /> 49049.IfV-5 is checked,check the appropriate box to describe the frequency ofvisual monitoring.
<br /> 49450.SUCTION PIPfNG MEETS EXEMPTION CRITERIA- Indicate ifthis mounting method is used to monitor the pipelines.
<br /> 49451.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM- Check this box if no
<br /> piping in the tank system is regulated under the UST law,or there is no piping.
<br /> 49452.V-99 OTHER-Indicate if aro Wer method is used for pipeline monitoring.
<br /> 490-53.SPECIFY-Enter a brief description of the other line monitoring method(s)used. If additional space is needed see Section X. Be sort 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,ere.). If you already have a diagram(e.g.,current UST Monitoring Site Plan from a Monitoring System Certification form,Hamrdous
<br /> Materials Business Plan map,etc.)that shows all required information,include it with this plan
<br /> UPCF UST-D(12/2007)214
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