BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

Feb. 4. 2009 3 46P — No. 1797 P. 4 t rein f 4p1>stywlee4tavleaadaltd pApp9'is' t UST Monitoring Plan—Page 2 Instructions Complete a separate UST Monitotdng Pian 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 prior to installing or modifying monitoring equipment. (Nott: Numbering of these instructions follows the data clement numbers on the form,) 4WMa,MONITORING OF THE UNDER DISPENSER CONTAINMENT-Indicate the method used for UDC monitoring. 490.54b,SPEC FY-if 99"Otheru checked describe other method nand If VI-1-1,VI-1-2 or Vbl J or VI-I-99 is chocked,complete 490.55 to 490.64b. 490.55. PANEL MANUFACTURER-Enter the name of the mmufecaucr of the monitoring system annual psrrJ(console). If them is M annum Panel(e.g.,oNy M electrical relay box is vutailed)leave this space blank. 49656. MODEL#- Enter tho modal numism for the morotonog system control panel(console).If there is ra control panel(e.g,only an electrical relay box is installed)leave this space blank 49657. LEAK SENSOR MANUFACTURER-Etiter the mama at the manulkerwar of the sercm(s). 49038.MODEL#(S)-Enter the model number of the seY40r(s)installed.If additional space is needed,use Section X. 49659, DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. Indicate Yes or No 490-60. UDC LEAK ALARM TRIGGERS PUMP SHUTDOWN- Indicate Yes or No 490-61. PAILURF/DISCONN&CTION OF UDC MONITORING SYSTEM TRICOERS AUTOMATIC PUMP SHUTDOWN-Indicate Yes or No 490.Q, UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER-Irdiem Yes or No. 490-63. UDC CONSTRUCTION- ladmte if the wasmation of the UDC is alnglo-waliod,or doublawalie4. 490-644 DOUBLE•WALIED INTERSTnIAL SPACEMONITORMO-Indicate what is used ae morritor the irdenv66ul spec, 49064b.LEAK WITHIN THE SECONDARY CONTAIMENT OF UDC TRIGGERS AUDIBLE AND VISUAL ALARMS-Indicate Yes or No 49665, VII-I ELD TESTING-Check the box ifyau have leen notified by the State Water Resources Comtel Board(SWRCB)that the UST(s)covered by this plan is/sm subject m EManad Leak Detection Requirements(i.e.,UST tis any single-wall component and Is located within 1,000 Rel of n public drinking water well). 490.66, TESTING OF SECONDARY CONTAINMENT COMPONENTS EVERY 36 MONMS-Check the box ifyou have secondarycontainment ted requires testing. 490-67. SPILL BUCKET TESTING-Check the box if you leave spill buckets. 49668th.VII RBCORDKEEPiNG•Indicate which monitoring and equipment maintenance records are maintained for this facility. 490-69a IX TRAINING,STATEMENT-Check the box to verify that the statement is true. REFERENCE DOCUMENTS MAINTAINED AT FACILITY-Check the app.prime boxes to describe reference documents maintained at the facility. Nate thin the first twin items on the list a=be kept at the fecdity. 490-69b. MONITORING PLAN:indinate that this plan is kept as a reference document. 490.69c. OPERATING MANUALS FOR ELECTRONIC EQUIPMENT:Indicate that this plan is kept M n reference document 490-69d. CA UST REGULATIONS-hdiana that this is kept as a referimc document. 490-69e. CA UST LAW-Indicate that this is kept as a reference document 490-W..STATE WATER RESOURCES CONTROL BOARD(SWRCB)PUBLICATION- "HANDBOOK FOR TANK OWNERS-MANUAL AND STATISTICAL INVENTORY RECONCILIATION-Indicate that this is kcpl u a refarenca document. 49669g SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS":Indicate that this is kept u a reRrence document 490491%OTHER-indicate that other reference documents are kept. 490491. SPECIFY-If"OTHER"u checked,estate tincfdescription ofNc other document(g)maintained at the facility.If additional space i8 needed,see Section X. 490.70. DESIGNATED OPERATOR TRAINING-Check this box to venfy that this smmment is true. 490-71. COMMENTS/ADDITIONAL M'ORMATION-Make additional comments or you may atmch and identify the number ofaddnional pages ofinformation to describe any additional UST system monitoring-related infonretion(e.g..additional infDnnsnon required by yaw local agancy) Attach any monitoring logs that you will he using for the monitoring ofyuurtank system. 490.72. NAME-Enter the name of the person who routinely conducts the monitoring and equipment maintenance under this plan. 49673. TITLE-Enter the title of the person 49674. NAME-Enter the name of the,wand person,if appiiabla who Munrely Conducts the monitoring said equipment maintenance under RNs plan. 490.75. TITLE•Erin+the tido of tM10 sewed panaon. OWNEWOPERATOR SIGNATURE-The tank owner/operator,fmility owner/opemmr,or an authorized mprtsentative ofnw owner shall sign in the space provided. This signature certifies thin the signer believes that all information submitted is true,accurate,and complete,and that the training pmgmm specified in Section IX has been implemented. 49676. REPRESENTING-Check the appropriate box to indicate whether the signer is the UST owner/opcntor,the UST facility owmr/oprnmr,or an avoorlxed representative ofthe owner. 49677. DATE-Enter the date the plan was signed. 49678. APPLICANT NAME-Print ortype the rame oftho person signing the plan, 490.79, APPLICANT TITLE-Enter the bre of rhe person signing the plan UPCF UST-D(171007)414