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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 prior 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#(s)in item 432 ofthe UST Operating Permit Application-Tank Information Forma)].
<br /> 1. FACILITY ID NUMBER-This space is for agency use 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 norther,ifapplicable.Post office box numbers are not acceptable
<br /> This information must provide a means to locate the facility geographically.
<br /> 104. CITY-Enter 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 /> 49063b Specify Other frequency for monitoring equipment servicing.
<br /> 490.4 SITE PLAN-Indicate if a site plammap is submitted with this monitoring plan or if it was submitted previously and is current for the facility.Mudtorag plans mat include
<br /> a Site Plot Plan/Map showing the tank and piping layouts and the locations where monitoring is performed(i.e.,location of semens,probes,line leak detectors,monitoring system
<br /> costal panel,ate.).
<br /> 490-5 IV-1 CONTINUOUS ELECTRONIC MONITORING-Indicate if this monitoring method is being used to monitor the tanks.
<br /> 490-6 SECONDARY CONTAINMENT-IfIV-1 is checked,check the appropriate box to describe the environment inside the tank secondary containment.
<br /> 490.7 PANEL MANUFACTURER--IfIV-1 is checked enter ft name of the manufacturer ofthe monitoring system control panel(console).
<br /> 490-8 MODEL#-If IV-1 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 ofthe 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 ifthis method is used for monitoring the UST's.
<br /> 490.12 PANEL MANUFACTURER-If IV-2 is checked,enter the name ofihe manufacturer ofthe monitoring system control panel(console).
<br /> 490.13 MODEL#-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 mace of the manufacturer of the Probe(s).
<br /> 490.15 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 /> 490-16.LEAK TEST FREQUENCY-IfIV-2 is checked,check the appropriate box to describe the in-tank leak test frequency.
<br /> 490-17.SPECIFY-If490-16e is checked,enter the frequency of progmmmed leak tests.
<br /> 490.18.PROGRAMMED TESTS-ITIV-2 is checked,check the appropriate box to describe the tests programmed into the ATG system.
<br /> 490.19.SPECIFY-If 4WISc is checked,emu the frequency of in-tank leak resting.
<br /> 490.20.IV-3INVENTORY RECONCILIATION-Check the box ifstatistical invemory reconciliation is performed.
<br /> 490.21.IV4 WEEKLY MANUAL TANK GAUGING.Indicate ifthis method is used to monitor the tanks.
<br /> 490.22.TESTING PERIOD-If I V4 is checked,check the appropriate box to describe the MTG testing period.
<br /> 490-23.IV-5 TANK INTEGRITY TESTING:Indicate ifthis 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 tearing.
<br /> 490-25.OTHER_117490-24c is checked,specify other test frequency.
<br /> 490.26.IV-99 OTHER Indicate if monitoring ofthe tanks occurs thin is not indicated in airy other category.
<br /> 490.27 If I V-99 is checked,enter a brief description ofthe other tank monitoring methods)used(e.g.,vadmis was monitoring per 23 CCR§2647,groundwater monitoring per
<br /> 23CCR§2648). Include the monitoring frequency(e.g.Continuous,W=kly). 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 ifthis 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 /> 490-30.PANEL MANUFACTURER-If V-1 is checked,emu the time ofthe manufacturer ofthe monitoring system control panel(console).
<br /> 490-31.MODEL is-If V-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 ofthe manufuchusix of the sensors).
<br /> 490.33.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 /> 490.34.PIPING LEAK ALARM T RIGGERS AUTOMATIC PUMP SHUTDOWN-If V-1 is checked,check Yes or No.
<br /> 490.35.FAILUREIDISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN-If V-I is checked,check Yes or No.
<br /> 490.36.V-2 PIPE MECHANICAL LINE LEAK DETECTORS PERFORM 3 GPH LEAK TESTS:Indicate ifthis monitoring method is used to monitor the pipelines.
<br /> 490.37.MLLD MANUFACTURER(S)-If V-2 is checked,enter the names)ofthe manufisommu(s)ofthe mechanical line leak detector(s).If additional space is needed,use
<br /> Section X.
<br /> 490.38.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 /> 490-39,V-3 PIPE ELECTRONIC LINE LEAK DETECTORS:Indicate ifthis monitoring method is used to monitor the pipelines.
<br /> 49040.ELLD MANUFACTURER-If V-3 is checked,Enter the name of the manufsumer ofthe electronic It=leak duccui(s).
<br /> 49041.MODEL#(S)n- If V-3 is checked,enter the model number for each type of elcdmnic It=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 oftests programmed into the monitoring system.
<br /> 490.43.ELLD DETECTION OF A PIPING LEAK ALARM TRIGGERS PUMP SHUTDOWN-If V-1 is checked,check Yes or No.
<br /> 490.44.ELLD DETECTION OF A PIPING LEAK FAILUREIDISCONNECTION TRIGGERS PUMP SHUTDOWN.-ff V-1 is ch=ked check Yes or No.
<br /> 490.45,V4 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 /> 490-47.SPECIFY-If 490.46-99 is checked,enter the frequency ofpipe integrity testing.
<br /> 49048.V-5 VISUAL PIPE MONITORING- Indicate if this monitoring method is used to monitor the pipelines.
<br /> 490-49.If V-5 is checked,check the appropriate box to describe the frequency ofvisual monitoring
<br /> 490.50.SUCTION PIPING MEETS EXEMPTION CRITERIA- Indicate ifthis monitoring method is used in monitor the pipelines.
<br /> 490.51.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.715 CONNECTED TO THE TANK SYSTEM- Check thisbox if no
<br /> piping in the tank system is regulated under the UST law,or there is no piping.
<br /> 490.52.V-99 OTHER-Indicate if another method is used for pipeline monitoring.
<br /> 490.53.SPECIFY-Enter a brief description of the other line monitoring melhod(s)used. If additionalspree is needed,s=Section X. Be am to clearly describe
<br /> monioring method(s)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(ag.,current UST Monitoring Site Plan from a Monitoring System Cerificaron form Ha sumom
<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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