BILLING 2009 - 2015 - Laserfiche WebLink

Home Browse Search

(Agency Use Only) This plan has been r t and: Approved ❑Approved With ondw Local Agency Signature Date: _ Corrosions or Special Conditions: UST Monitoring Plan—Page 2 Instructions Complete a separate UST Monitoring Plan for each UST monitoring system at the facility. This forth 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. (Note: Numbering of these instructions follows the data element numbers on the form.) 490-54a MONITORING OF THE UNDER DISPENSER CONTAINMENT.Indicate the method used for UDC monitoring. 490-54b.SPECIFY-If99"Other"is checked,describe other method used. If VI-1-1,VI-1-2 or VI-1-3 or VI-1-99 is checked,complete 490-55 ro 490-64b. 490-55, PANEL MANUFACTURER-Enter the name ofthe manufacturer of the monitoring system control panel(console). Ifthere is no control panel(e.g.,only an electrical relay box is installed)leave this space blank. 490-56. MODEL k- Ender 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-Earn the name ofthe manufacturer ofthe sensor(s). 490-58. MODEL k(S)-Erne the model number ofthe sereor(s)installed.Ifadditional space is needed,use Section X. 490-59. DETECTION OF A LEAK IMO 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. FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN-Indicate Yes or No 490-62. UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER-Indicate Yes or No. 490.63. UDCCONSTRUCDON- Indicateiftheconstructionofthe UDCiSsingle-walled,ordouble-walled. 490-64a.DOUBLE-WALLED INTERSTITIAL SPACE MONITORING- Indicate what is used to monitor the interstitial space. 49064b.LEAK WITHIN THE SECONDARY CONTAIMENT OF UDC TRIGGERS AUDIBLE AND VISUAL ALARMS-Indicate Yes or No 490-65. VII-1 ELD TESTING-Check the box ifyou have been nu fled by the State Water Resources Control Board(SWRCB)that the UST(s)covered by this plan is/. 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). 49066. TESTING OF SECONDARY CONTAINMENT COMPONENTS EVERY 36 MONTHS-Check the box if you have secondary containment that requires testing. 49067. SPILL BUCKET TESTING-Check the box if you have spill backers. 490-68ah.VIII RECORDKEEPING-Indicate which monitoring and equipment meimerimrce records are maintained for this facility. 49069a Of TRAINING STATEMENT-Check the box to verify thin the statement is true. REFERENCE DOCUMENTS MAINTAINED AT FACILITY-Check the appropriate boxes to describe reference documents maintained at the facility. Note that the first two items on the listiris t be kept at the facility. 49069b. MONITORING PLAN:Indicate that this plan is kept as a reference document. 49069c. OPERATING MANUALS FOR ELECTRONIC EQUIPMENT:Indicate that this plan is kept as a reference document. 49069d. CA UST REGULATIONS-Indicate that this is kept as a reference document. 49069e. CA UST LAW-Indicate that this is kept as a reference document. 49069E STATE WATER RESOURCES CONTROL BOARD(SWRCB)PUBLICATION- "HANDBOOK FOR TANK OWNERS-MANUAL AND STATISTICAL INVENTORY RECONCILIATION-Indicate that this is kept as a reference document. 49069g.SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS":Indicate that this is kept as a reference document 49069h.OTHER-Indicate thin other reference documents are kept. 49069i. SPECIFY-If"OTHER"is checked,enter a brief description ofthe otherdocument(s)maintained at the facility.Ifadditional space is needed,see Section X. 490.70. DESIGNATED OPERATOR TRAINING-Check this box to verify that this statement is nue. 490-71. COMMENTS/ADDITIONAL INFORMATION-Make additional comments or you may attach and identify the number of addenonal 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 that you will be using for the monitoring ofyour tank system. 490.72. NAME-Enter the name ofthe person who mutincly conducts the monitoring and equipment maintenance under this plan. 490-73. TITLE- Enter the tide ofthe person. 490.74. NAME-Enter the name ofthe second person if applicable,who routinely conducts the monitoring and equipment maintenance under this plan. 490.75. TITLE- Enter the fide of the second person. OWNER/OPERATOR SIGNATURE-TM tank owner/operator,facility owner/operator,or an authorized representative of the ii n shall sign in the space provided. This signature certifies that the signer believes the all information submitted is true,accurate,and complete,and that the training program specified in Section 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 an authorized representative of the 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 title of the person signing the plan. UPCF UST-D(12/2007)4/4