COMPLIANCE INFO_2005 - 2008 - Laserfiche WebLink

Home Browse Search

(Agency Use Oa1y1 This plan has been m. mnl: ❑Approved ❑Approved With Cond tion Local Agency Signature: Dare: Comments or Special Conditions: UST Monitoring Ptan—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 inquire you to obtain approval Driof 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-Indra the method used for UDC monitoring. 490-54b.SPECIFY-1f 99"Other'is checked,describe other method used- IfVI.1-I,VI-1-2 or V1-1-3 or V1-1-99 is cbacked,comdem 490-55 an 490.64h 490-55. PANEL MANUFACTURER-Enter the nomeofthe manafaztuerofthe monitoring system nw cannot panel(wle). If them ism control panel e.g'only an electrical relay box is instilled)leave this space blank 490-56. MODEL N- Enter the model number for the monitoring system control panel(console).If that is an wmrol pend(e.g.,only an electrical relay box is installed)leave this space blank. 490.57. LEAK SENSOR MANUFACTURER-Enter the Hare of the maonfewaer of the sensor(s). 490-5& MODEL N(S)-Enter the model number of the sewout s)installed.If additional space is needed,me Section X. 490.59. 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.FAILURE(DISCONNECTION OF UDC MONITORING SYSTFMTRIGGPRS AUTOMATIC PUMP SHUTDOWN-Indicate Yes or No 490-62. UDC MONITORING STOPS TEE FLOW OF PRODUCT AT THE DISPENSER-Indicate Yes"No. 49063. UDCCONSTRUCf10N- hdieme if the coourocdon of the UDC is smigevnilled,ordoublowalled. 49MU DOUBLE-WALLED INTERSTITIAL SPACE MONITORING- Indicate whet is used in monitor the interstitial space. 490-64b.LEAK WITHIN THE SECONDARY CONTAQMWr OF(IDC TRIGGERS AUDIBLE AND VISUAL ALARMS-Indicate Yes or No 49065. VII-I ELD TESTING-Check the box if you have been notified by the Suite Water Resources Control Board(SWRCB)that the UST(s)covered by this plan is/= subject to Enhanced Leek Getman Regwmnents(i.e.,UST has any singlawall component and is located within 1,000 feet of a public drinking wafer well). 490.66. TESTING OF SECONDARY CONTAINMENT COMPONENTS EVERY 36 MONDIS-Check the boxWynn have ucondeny conesisnom Wart regoims mating 490.67. SPILL BUCKET TESTING-Check the box if you have spill buckets. 490-65a-h VII RECORDKEEPING-1miare which mounting and equipment maintenance records as maintained for this facility. 490-69a IX TRAINING STATEMENT-Check the box in verify that the statement is not. REFERENCE DOCUMENTS MAINTAINED AT FACILITY--Check the appropriate boxy mo describe reference dmumems maimaimd m to facility. Note that the Ecu ton mevn on the list mant be kept a the facility. 490696. MONITORING PIAN:Indicate that this plan is kept as a reference thermostat 49(F69c.OPERATING MANUALS FOR ELECTRONIC EQUIPMENT.Indian Wad this plan is kept as a reference dmument. 490-69th CA UST REGULATIONS-Indicate that this is kept az a reference documem. 490-69e CA UST LAW-Indicate that this is kept as a reference document 490-69C STATE WATER RESOURCES CONTROL BOARD(SWRCB)PUBLICATION- "HANDBOOK FOR TANK OWNERS-MANUAL AND STATISTICAL INVENTORY RECONCILIATION-Indican tennis Iskepd as a reference documtat 490698 SWRCB PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS":Indicate that this is kept w a reference dwmncrnl 490-69h OTHER-Inflate gut other refemxx doc meds am kept 490-69i. SPECIFY-if'OrHER"is checked,enter a brief description of the other document(s)mmmired at the facility.If additional space is needed,use Section X. 490-70. DESIGNATED OPERATOR TRAINING-Check this box m verify that this statement is nue. 490-71. COMMENTS/ADDITIONAL INFORMATION-Make additional comments or you may stench and identify the number of additional pages of information to describe any additional UST system mommring-mlamed information(e.g,additional information required by your local agency). Attach any motmoring logs that you will be using for the ruminants of your lank system 490.72. NAME-Ewer tictiome of the person who routinely conducts the monitoring and equipment immanence under this plan. 490-73.TITLE- Enter the title of the person. 490-74. NAME-Enter the name of the second person.ifeWhable,who routinely conducts the monitoring and equipment maintenance under this plan. 490.75. Tfl'LE- Emerihe tide ofthe..it pecan. OWNER/OPERATOR SIGNATURE-Tic rank owne lope tsar,facility owner/openater,or an authorized representative of the owmor shall sign in the space provided This signatue tatifies that the signor believes tat all infomatmn submitted is uue accinate,and complem,and fiat the training program specified in Secnoo IS has been implemented 490.76. REPRESENTING-Check the appropriate box to indicate whether the signer is the UST ownedopcmlxr,the UST facility owner/operator,or an authorized representative of the owner, 490-T1. DATE-Enter the dere the plan was signed- 490.78. igned490.78. APPLICANT NAME-Pum or type the tune of the person signing the plan. 490-79. APPLICANT TITLE-Enter to title of the person signing the play. UPCF UST-D(122007)414