INSTALL_2013 - Laserfiche WebLink

Home Browse Search

(Agency Use Only) This plan b evic end: pproved ❑Approved With Conditions' Disapproved Local Agency Signature: Date: � Q I Comments or Special Conditions: Le `^ UPCF UST Monitoring Plan-Page 2 Instructions 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 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-If 99"Other"is checked,describe other method used. If VI.1-1,VI.1.2 m VI.1-3 m VI-1-99 is checked,complete 490.55 to 490.646. 490-55. PANEL MANUFACTURER-Enter the name of the manufacturer of die monitoring system control Panel(console)- Ifthereis noccnaulpancl(e.g.,only an electrical relay box is Installed)leave this space blank. 490-56. MODEL#-Enter the model number for the monitoring system control panel(console).If them is no control panel(a.&,only an electrical relay box is installed)leave this space black. 490-57. LEAK SENSOR MANUFACTURER-Enter the name of the manufacturer of the senaor(s). 490-58. MODEL#(S)-Enter the model number of the sawor(s)installed.If additional space is needed,use Section X. 49059. DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. Indicate Yea or No. 49060, UDC LEAK ALARM TRIGGERS PUMP SHUTDOWN-Indicate Yes or No. 49061. FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN-Indicate Yes or No. 49062. UDC MONITORING STOPS THE FLOW OF PRODUCE AT THE DISPENSER-Indicate Yes or No. 49063. UI)C CONSTRUCTION-Indicate if the construction of the UDC is single-walled,or doublo-walled. 490-64a DOUBLE-WALLED INTERSTITIAL SPACE MONITORING-Indicate what is Used to monitor the interstitial apace. 490.64b.LEAK WITHIN THE SECONDARY CONTAINMENT OF UDC TRIGGERS AUDI13LE AND VISUAL ALARMS-Indicate Yes or No. 49065. VB-1 ELD TESTING-Check the box if you have been notified by the State Water Resources Control Board(SWRCB)that the UST(s)covered by this plan is/are subject to Enhanced Leet Detection Requirements(i.e.,UST has any single-wall component and is located within 1,000 feet of public drinking water well). --.._..-490=66:--TESTING OF-SECONDARYE'ONTAINMENp COMPONENTS-E'VERY36MONTHS--Check-theRox-ifyonhavesecondary containment that regalres-testing.. --...... 490-67. SPILL BUCKET TESTING-Check tbebox if you have spill buckets. 490-68. VHI RECOROKEEPING-Indicarwhich monitoring and equipment maintenance records am maintained fm thisfacility. 490-69a. IX TRAINING STATEMENT-Check the box to verify that the stetememt is true. REFERENCE DOCUMENTS MAINTAINED AT FACILITY-Check the appropriate boxes to describe reference documents maintained at the facility. Note that the that two items on the list most be kept at the facility. 490-69b.MONITORING PIAN:Indicate that this plan is kept as a reference document 490-69c. OPERATING MANUALS FOR ELECTRONIC EQUIPMENT:Indicate that this plan is kept w a reference document 490-69d.CA UST REGULATIONS-Indicate that this is kept as a reference document. 490-69e. CA USTLAW-Indicate that this is kept as arefurence document 490-69E STATE WATER RESOURCES CONTROL BOARD(SWRCB)PUBLICATION-"NANDBOOKFOR TANK OWNERS-MANUAL AND STATISTICAL INVENTORY RECONCILIATION:Indicant that this is kept as areference document 490-69g.SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS":Indicate that this is kept as a reference document. 490-69h.OTHER-Indicate that other reference documents are kept 490-69i. SPECIFY-H"OTHER"is checked,enter a brief description of the other docment(s)maintained at the facility.If additional space is needed,see Section X. 490-70. DESIGNATED OPERATOR TRAINING-Cbeck this box to verify that this statement is true. 49071. COMMENTS/ADDI'1'IONAL INFORMATION-Make additional comments or you may attach and identify the number of additional pages of information to describe any additional UST system monitoring-related information(a.g.,additional information required by your local agency). Attach any monitoring logs that yen will be using for the monitoring ofyour tank system 49072. NAME-Enter the name ofthe person who routinely conducts the monitoring and equipment maintenance under this plan. 490-73. TITLE-Enter the title of the person 49074. NAME-Enter the name ofthe second person,ifapp8cable,who routinely conducts the monitoring and equipment maintenance under this Plan. 49075. TITLE-Enter the title of the second person. OWNER/OPERATOR SIGNATURE-The tank owner/operetor,facility owner/operator,or an authorized representative of the owner shall sign in the space provided. This signature certifies that the signer believes that all information submitted is true,accurate,and complete,and that the training program specified in Section IX has leen implemented 49076. REPRESENTING- Check the appropriate box to indicate whether the signer is the UST owner/operator, the UST facility owner/operator, or an authorized repros estative ofthe owner. 49077. DATE-Enter the date the plan was signed. 49078. APPLICANT NAME-Print or type the name of the person signing the plan. 49079. APPLICANT TITLE-Enter the title ofthe person signing the plan. UPCF UST-D(12/2007)-4/4 www.umdocaorg