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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 >i rior 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 a[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#(s)in item 432 ofthe UST Operating Permit Application-Tank Information Form(s)].
<br /> 1. FACILITY ID NUMBER-This space is for agency use only.
<br /> 3. BUSINESS NAME-Ewer 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 most provide a means to locate the facility geographically.
<br /> 104. CITY-Enter the city or muncorporated 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 /> 490-36 Specify Other frequency for monitoring equipment servicing.
<br /> 4904 SITE PLAN-Indicate ifa site plan/map 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 Plan/Map showing the tonic and piping layouts and the locations where monitoring is performed(i.e.,location of sensors,probes,line leak detectors,monitoring system
<br /> control Pont,etc.).
<br /> 490-5 IV-1 CONTINUOUS ELECTRONIC MONITORING-Indicate ifthis monitoring method is being used to monitor the tanks.
<br /> 490-6 SECONDARY CONTAINMENT-ICIV-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 ofthe manufncNrer ofthe monitoring system control panel(console).
<br /> 490.8 MODEL#-If IV-1 is checked,met the model number for the monitoring system control panel.
<br /> 490.9 LEAK SENSORMANUFACTURER-IfIV-l is checked,enter the name ofthe manufacturer ofthe s,wm(s).Ifadditional space is needed,use Section X.
<br /> 49010 MODEL#(S)--IPIV-1 is checked,enter the model number for each type of sensor installed.If additional space is needed,use Section X.
<br /> 49011 IV-2 AUTOMATIC TANK GAUGING-Indicate ifthis method is used for monitoring the UST's.
<br /> 49012 PANEL MANfUFAC1URER-If IV-2 is checked,enter the name ofthe manufacturer ofthe monitoring system control panel(console).
<br /> 49013 MODEL#-ICIV-2 is checked,exact the model number for the monitoring system control panel.
<br /> 49014 IN-TANK PROBE MANUFACTURER-If IV-2 is checked,enter the name of the manufacturer ofthe probe(s).
<br /> 49015 MODEL#(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 /> 49016.LEAK TEST FREQUENCY-IPIV-2 is checked,check the appropriate box to describe the in-tank leak test frequency.
<br /> 49017.SPECIFY-11749D-1 6c is checked,ewer the frequency of programmed leak tests.
<br /> 49018.PROGRAMMED TESTS-IfIV-2 is checked,check the appropriate box to describe the tests programmed into the ATG system.
<br /> 49019.SPECIFY-If 490.1&is checked,enter the frequency of in-tank leak testing.
<br /> 49020.IV-3 INVENTORY RECONCILIATION-Check the box ifstatistical inventory reconciliation is performed.
<br /> 49021.IV-4 WEEKLY MANUAL TANK GAUGING.Indicate ifthis method is used to monitor the tanks.
<br /> 49022.TESTING PERIOD-IPIV4 is checked,check the appropriate box to describe the MTG testing period.
<br /> 49023.IV-5 TANK INTEGRITY TESTING:Indicate ifthis method is used to monitor the tanks.
<br /> 49024.TEST FREQUENCY-If IV-5 is checked,check the appropriate box to describe the frequency of tank integrity testing.
<br /> 49025.OTHER:117490-24c is checked,specify other test frequency.
<br /> 49026.IV-99 OTHER:Indicate if monitoring ofthe tanks occurs that is not indicated in any other category.
<br /> 49022 IfIV-99 is checked,enter a brief description ofthe other tank monitoring method(s)used(e.g.,vadow zone monitoring per 23 CCR§2647,groundwater monitoring per
<br /> 23CCR§2648). Include the monitoring frequency(e.g.,Continuous,Weekly). Ifadditional space is needed,use Section X.
<br /> 49028. V-1 CONTINUOUS MONITORING OF PIPEIPIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIB LE AND VISUAL ALARMS:
<br /> Indicate ifthis is the monitoring method used for the piping.
<br /> 49029.SECONDARY CONTAINMENT:If V-I is checked,Check the appropriate box to describe the environment inside piping secondary containment
<br /> 49030.PANEL MANUFACTURER-If V.I is checked,cover the name ofthe manufacturer ofthe monitoring system control panel(console).
<br /> 4903 L MODEL#-If V-1 is checked,enter the model number for the monitoring system control panel.
<br /> 49032.LEAK SENSOR MANUFACTURER-If V-1 is checked,enter the name of the manufacturer ofthe sewor(s).
<br /> 49033.MODEL#(S)-If V-1 is checked,most the model number for each type of sensor installed.Ifadditional 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.FAILUREIDISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUf'DOWN-If V.I is checked,check Yes or No.
<br /> 49036.V-2 PIPE MECHANICAL LINE LEAK DETECTORS PERFORM 3 GPH LEAK TESTS:Indicate if this monitoring method is used to monitor the pipelines.
<br /> 49037.MLLD MANUFACTURER(S)-If V-2 is checked,ewer the oame(s)of the manufacNrer(s)ofthe mechanical line leak detector(e).Ifadditional space is needed,use
<br /> Section X
<br /> 49038.MODEL#(a)-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 DETECTORS:Indicate if this monitoring method is used to=rotor the pipelines.
<br /> 490-40.ELLD MANUFACTURER-If V-3 is checked,Enter the name of the manufacturer of the electronic line leak detector(s).
<br /> 49041.MODEL#(S)an- If V-3 is checked,ewer 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 N describe the type oftesis 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.ELLD DETECTION OF A PIPING LEAK FAIL URE/DISCONNECTION TRIGGERS PUMP SHUTDOWN.-If V-I is checked,check Yes or No.
<br /> 49045.V<PIPE INTEGRITY TESTING-Indicate ifthis monitoring method is used to monitor the pipelines.
<br /> 49046.TEST FREQUENCY-If V4 is checked,check the appropriate box to describe the frequency of pipe integrity testing.
<br /> 49047.SPECIFY-If 490-46-99 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 ofvisual monitoring.
<br /> 49050.SUCTION PIPING MEETS EXEMPTION CRITERIA- Indicate ifthis monitoring method is used to monitor the pipelines.
<br /> 49051.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 /> 49052.V-99 OTHER-Indicate if mother method is used for pipeline monitoring.
<br /> 49053.SPECIFY-Enter a brief description ofthe other line monitoring methods)wed. Ifadditional 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 Certifmcauon form Hazardous
<br /> Materials Business Plan map,etc.)that shows all required information,include it with this plan
<br /> UPCF UST-D(12/2007)2/4
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