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<br /> UST Monitoring Plan-Pap I Instructions
<br /> Complete a separate UST Monitoring Plan for each UST monitoring system at the facility. This form most be submitted with your leddal UST Operating Permit
<br /> Application and within 30 days of changes in the Information It eentehis. Please note that your local agency may require you to obtain approval gft to Installing or
<br /> modifying monitoring equipment. (Note: Numbering of these Instructions fogows the data densest numbers on the form.)
<br /> 490.1. TYPE OF ACTION-Cheek the appropriate box to indicate why this plan is being submitted.
<br /> 490-2, PLAN TYPE-Check the appropriate lox to indicate whether this plan covers all,or merely some,of the USTs at the facility. If the plan covers only some of the tanks,
<br /> identify those tanks in the space provided[e.g.,by using the Tank ID#(s)in item 432 of the UST Operating Permit Application-Tank Infometion Fom(s)].
<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 number,if applicable Post office box numbers are not acceptable
<br /> This information must provide a means to hate 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 spec4 the frequency of monitoring equipment tosting/certification.
<br /> 490-3b Specify Other frequency for monitoring equipment servicing.
<br /> 490-4 SITE PLAN-Indicate if a 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 tank and piping layouts and the locations where monitoring is performed(i.e..location of sonsors,probes,line leak detectors,monitoring system
<br /> control pard,etc.).
<br /> 490-5 IV-i CONTINUOUS ELECTRONIC MONITORING-Indicate if this monitoring method is being used to monitor the tanks.
<br /> 490.6 SECONDARY CONTAINMENT-If N-1 is checked,check the appropriate box to describe the environment inside the tank stxxmdary containment.
<br /> 490-7 PANEL MANUFACTURER--IfIV-1 is checked,cater the no=of the Manufacturer of the monitoring system control panel(console).
<br /> 490-8 MODEL#-If IV-1 is cheeped,enter the model number for the monitoring system control panel.
<br /> 490-9 LEAK SENSOR MANUFACTURER-if IV-1 is checked,enter the name of the manufacturer of Ste 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 if this method is ted for monitoring the UST's.
<br /> 490-12 PANEL MANUFACTURER-If IV-2 is checked,enter the name of the manufacturer of the monitoring system control pfarel(console).
<br /> 490.13 MODEL#-If IV-2 is checked,enter the model number for the monitoring system control pand.
<br /> 490-14 IN-TANK PROBE MANUFACTURER-If IV-2 is checked,eater the name of the manttthcturer of the prows).
<br /> 490-15 MODEL#(S)-If IV-2 is clucked,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-If IV-2 is checked,check the appropriate lox to describe the in-tank teak test frequency.
<br /> 490-17.SPECIFY-If 490-16e is checked,enter the frequency ol7programmed leak tests.
<br /> 490.18.PROGAAWI V ED TESTS-If IV-2 is checked,check the appropriate lox to describe the tests programmed into the ATG system
<br /> 490.19.SPECIFY-If 490-18e is checked,enter the frequency of in-tank leak testing.
<br /> 490.20.IV-3 INVFWrORY RECONCILIATION-Check the box if statistical inventory reconciliation is perfor ed.
<br /> 490-21.IV-4 WEEKLY MANUAL TANK GAUGING.Indicate ifthis method is used to monitor the tanks.
<br /> 490-22.TESTING PI^:RIOD-if TV-4 is checked,check the appropriate box to describe the MTG testing period.
<br /> 490-23.1 V-5 TANK INTEGRITY TESTING:Indicate if this method is used to monitor the tanks.
<br /> 490-24.TEST FREQUENCY-If N-S is checked,check the appropriate box to describe the frequency of tank integrity testing.
<br /> 490-25.OTHER:If 490-24c is clucked,specify other test
<br /> 440-26.IV-99 OTHER:Indicate if nonitoring of the tanks occurs that is not indicated in my other
<br /> 490-27.If IV-99 is checked,enter a brief desetiprtion of the other tank monitoring method(s)used(e.g.,vadose zone monitoring per 23 CCR§2647,groundwater monitoring per
<br /> 23CCR§2648). Include the monitoring frequency(e.g.,Continuous,Weekly). If additional space is needed,we Section X.
<br /> 490.28. V-1 CONTINUOUS MONITORING OF PtPEIPIPING SUMP(S)AND OTHER SECONDARY CONTAINMENT WITH AUDIB LE AND VISUAL ALARMS:
<br /> Indicate if this 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,enter the name of the manufacturer of the monitoring system control panel(console
<br /> 490-31.MODEL#-If V-i is chucked,enter the model number for the Monitoring system control panel.
<br /> 490-32.LEAK SENSOR MANUFACTURER-If V-1 is checked,enter the name of the manufacturer of the sensor(s).
<br /> 490-33.MODEL#(S)-If V-I 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 R IGGERS AUTOMATIC PUMP SHUTDOWN-If V-1 is checked,check Yes or No.
<br /> 490-35.FAILURE/DISCONNECTItt;d OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN-If V-1 is checked,chuck 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 /> 490-37.MLLD MANUFACTURER(S)-If V-2 is checked,enter the name(s)of the unumfacturer(s)of the mechanical line leak detector(s).If additional space is nceded,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 /> 49039,V-3 PIPE ELECTRONIC LINE LEAK DETECTORS:Indicate if this monitoring method is used to monitor the pipelines.
<br /> 490-40.ELLD MANUFACTURER-If V-3 is checked,Enter the name of the manufacturer of the electronic lire leak delector(s).
<br /> 490-41.MODEL#(S)n- If V-3 is checked,enter the model number for each type of electronic line leak detector installed.If additional space is needed,use Section X,
<br /> 490-42.PROGRAMMED LINE INTEGRITY TESTS If V-3 is chucked,check the appropriate box to describe the type of tests progrommed into the monitoring system.
<br /> 440.43.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 FAILURE/DISCONNECTION TRIGGERS PUMP SHUTDOWN.-If V-1 is checked,check Yes or 1o.
<br /> 49045.V-4 PIPE INTEGRITY TESTING-Indicate if this monitoring method is used to monitor the pipelines.
<br /> 49046,TEST FREQUENCY-if V-4 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 fine fi-equency of pipe integrity testing.
<br /> 49048.V-5 VISUAL PIPE MONITORING- Indicate if this monitoring method is used to monitor the pipelines.
<br /> 49049.If V-5 is chucked,check the appropriate boa:to describe the frequency ofvisual monitoring
<br /> 49050.SUCTION PIPING MEETS EXEMPTION CRITERIA- Indicate if this monitoring method is used to monitor the pipelines.
<br /> 490-51.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7IS CONNECTED TO THE TANK SYSTEM-Checkthis box 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 /> 49053.SPECIFY-Ener a!mien descriptionthe
<br /> monitoring methods)and frequency.. other line monitoring method(s)teed. If additions]space is reeled,see SectiOn X. Be sure to dearly describe
<br /> This monitoring plan roust include a Site flat showing the general tank and piping layouts and the locations where monitoring is performed(i.e..location of each sensor,line teak
<br /> detector,monitoring system control pari,etc.). If you already have a diagram{e g.,current UST Monitoring Site Ran from a Monitoring System Certification foray Hazardous
<br /> Materials Business Plan nap,etc.)that shows all required information,include it with this plan.
<br /> UPCF UST-D(12/2007)2/4
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