Laserfiche WebLink
(Agency Use Only) This plan has beenreviewedand: P-2�pprovcd ❑Approved With Conditions [j Disapproved <br /> Local Agency Signature:__&L �(y Date: �l 6 101 <br /> I -- <br /> C:onttuents or Spuuial Conditions: --- -- -- -. �-- <br /> UPCF UST Monitoring Plan — Page 2 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 <br /> Operating Permit Application and within 30 days of changes in the information it contains. Please note that your local agency may require you to <br /> obtain approval prior to installing or modifying monitoring equipment. (Note: Numbering of these instructions follows the data element numbers on <br /> the form.) <br /> •I.-l�)E�-Att�D'I�tti-�•-N,c+HI:-that-ul�+��+HaiM-bet�fu:a-k>-�+�sr+t�+Hs;+Hitk+rt+tg•Hb'-Eat�L�yww+H'a� -by-tt+►s-pkttr�. <br /> 490-54a. MONITORING OF TIIE UNDER DISPENSER CONTAINMENT-Indicate the method used for UDC monitoring. , . <br /> apprel+riata-bc+x(++s}tc�i�aHl+i'y-aN-�equireek-medx+ds-t+sad-i�r-rHHHilt+ring-ttte-i+rra(r}t�rncattlttl+cs d+spa+tsar4�}:-C-haHl�-ita+t+-49A-eta-1-i€-the-i�=is-++aHHitHr�t <br /> by-a-Irakem- innitHrac�4iv a <br /> meelm-nicAl 6M.49641181614WS tile jiSPO........ hA_A_--v-alvev.,han litioid In the UPC lifts Aleak d-eleotion'" "hook kel"4Q@ 54a 3 if thO InjP0 iS;V19R40F6d 11!A <br /> _ - _ <br /> 490-54b. SPECIFY- if 99 "Other" is checked, describe other method used. SPEC aFY— f caked <br /> +a on keritrg n;at #+au�i�+aeadrd Hsd�;autiHr+��- H aleaF4y deser+l+r ttxataitHwi+ag taartHrdFs}t++►d ti,c}a+dHta <br /> If VI-1-1,VI-1-2 or VI-1-3 or VI-1-99 is checked,complete 490-55 to 490-64b. <br /> 490-55. PANEL MANUFACTURER-Enter the name of the manufacturer of the monitoring system control panel(console). If there is no control panel(e.g.,only an electrical <br /> relay box is installed)leave this space blank. H � <br /> +nHtaitH�iHg-sy+.trsraa�+HHtr�l-panel-(•HH+aseld} <br /> 490-56. MODEL#-Enter 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 <br /> this space blank. Patiol. <br /> 490-57. LEAK SENSOR MANUFACTURER-Enter the name of the manufacturer of the sensor(s).6PAK SENSOR MANUFACTURF;R 4­181211'190 540 1 OF 490 54a <br /> 3-is-c+HeHkad-a+atrr�Hr+aaHaa-et=th�rHaHttGa<;tt+rrFaf-the-senesce(}}:-l.t�mHrr•space-is-+teatled�e-SeHEieH-� <br /> 490-58. MODEL#(S)-Enter the model number of the sensor(s)installed. If additional space is needed,use Section X. 'A°"54a 3 isT <br /> rhaeked enter tkte-++andel tatHHber fiar eat4a typo e€ia+Mrr imtalled-lft++Hre space is rteedrd tttia Saetie+a�F <br /> 490-59. DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS. Indicate Yes or No.WIl .^T Elmet9N OF�i[AAlm. INTO Tuc <br /> NP WSWAI,A66,141+49 <br /> 490-60, UDC LEAK ALARM TRIGGERS PUMP SHUTDOWN-Indicate Yes or No.Wit�.,blz UPC LSA A V- ALARM TRIGGER RUMP 9IUTPQAZNq 911061i 346 a <br /> l*lH: <br /> 490-61. FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN - Indicate Yes or No. <br /> Or-LXJCPA . <br /> 490-62. UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER-Indicate Yes or No. <br /> ��/14i'DD/int 1!`T AT TLi �DiC,"yA ��D I(DllAi t C A 1' f1CTC/`Ti(lAl') Chooky-O&OF, ,. <br /> 490-63. UDC CONSTRUCTION- Indicate if the construction of the UDC is single-walled,or double-walled. <br /> indicatrivhetI*P4he-lJDC-has single-wall )r-douhle-A4[-GHnstfue6oti-1 -yoo-shed,-4km-190-63-}-,�)4o-Peetion V11. <br /> 490-64a. DOUBLE-WALLED INTERSTITIAL SPACE MONITORING-Indicate what is used to monitor the interstitial space.610-C INTERSTIT <br /> e Hack-ita++t�l9(1-6:3-2 ehaHlrtlar apPrHtxiatr be�x t{�da;e+ihr tier tytaa H€-veoaaHa/Iarrasafa41ydF0AHtir l uPW 1 anHn+tH iHg I+kwitlad-fart Nae lid sea+eFlda+y <br /> eeHteifaH+eraF: <br /> 490-64b. LEAK WITHIN THE SECONDARY CONTAINMENT OF UDC TRIGGERS AUDIBLE AND VISUAL ALARMS-Indicate Yes or No.`vt r t nrTnrTION Or- A <br /> 490-65. VII-I 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 <br /> subject to Enhanced Leak Detection Requirements(i.e.,UST has any single-wall component and is located within 1,000 fact of a public drinking water well).lam) <br /> =FES'1"l".'1�,=•-I`Hank-4laic;-bta+ci€-tier-£113-1aas-eHN€+ad-yH+t-tl+at-yE>a-mannt-pefl'Hftn-per-itatic:-I::+aba+a��d-6aak-E3etEwk��na��' r-��,-r;.-dH-nHt-+aaad-tE>...cnlaerk-this <br /> box ifyou Owed to brm one ilme 61,14)testing(e.g.,pos i llittion wsWig) <br /> 490-66. TESTING OF SECONDARY CONTAINMENT COMPONENTS EVERY 36 MONTHS - Check the box if you have secondary containment that requires <br /> testing.'.. . ew soo iadary <br /> 490-67. SPILL BUCKET TESTING-Check the box if you have spill bucketi;46 BUEKE•f TE£iTINCd— a+..a� �laR+..- Tis'- v a�+)d Pfe.�idr an+aaxl kaSFitag~ tFl <br /> 615'T-4'rla-spill bttokels: <br /> 490-68. VIII RECORDKEEPING - Indicate which monitoring and equipment maintenance records are maintained for this facility. <br /> refafi+Nc+txNc : + Hfds-kryt tt3wtl3a faeilit <br /> IX,- 44A4N4NG <br /> 490-69a. IX TRAINING STATEMENT-Check the box to verify that the statement is true. <br /> REFERENCE DOCUMENTS MAINTAINED AT FACILITY-Check the appropriate boxes to describe reference documents maintained at the facility. Note that the <br /> first two items on the list must be kept at the facility.GHaok Nae#+ le Na' + f++ <br /> witH frlevant-frferrnea cl< to+a3rntrEHnek the appfePrticHa bHxrs for items 490 69b thnmgh-4a to identify fr#ara+wa deeumaHts Nast ltfe+atai+ateiRed-at-4he <br /> #aeilini-PIHIN tHet-+tdHl 499-F�9ki Haad-r afrilaaHdatHrj <br /> 490-69b. MONITORING PLAN:Indicate that this plan is kept as a reference document. <br /> 490-69c. OPERATING MANUALS FOR ELECTRONIC EQUIPMENT:Indicate that this plan is kept as a reference document. <br /> 490.69d. CA UST REGULATIONS-Indicate that this is kept as a reference document. <br /> 490-69e. CA UST LAW-Indicate that this is kept as a reference document. <br /> 490-69f. STATE WATER RESOURCES CONTROL BOARD(SWRCB)PUBLICATION- "HANDBOOK FOR TANK OWNERS-MANUAL AND <br /> STATISTICAL INVENTORY RECONCILIATION":Indicate that this is kept as a reference document. <br /> 490-69g, SWRCD PUBLICATION:"UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS":Indicate that this is kept as a refe(ence document. <br /> 490-69h.OTHER-Indicate that other reference documents are kopt. <br /> UPCF UST-D(13/3007)-6/7 www.unioogs.org <br />