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<br /> UST Mosiltering Plan-pap i Instructions
<br /> a
<br /> Complete a separate UST Monitoring Plan for each UST monitoring system at the facility. This form must be submitted with
<br /> Application and within 30 days of ch in the In tahst.tion it conPlanta note that your keel your Initial UST Operating Permit
<br /> modifying monitoring t. (Note: Nu ng of these i instructions follows the data numbers moY I°u m obtain approval BEI9E o installing or
<br /> on the form
<br /> 490-1. TYPE OF ACTION-Check the appropriate lox to indicate why this plan is beim d,submitte )
<br /> 490-2. PLAN TYPE-Check the appropriate box to indicate whether this plait covers all,or merely sonic,of tie USTs at the fie lity. 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
<br /> 1. FACILITY ID NUMBER-This Operating Permit Application-Teak Information Form(s)].
<br /> is for use only.
<br /> 3. BUSINESS NAME-Enter the complete Facility Name.
<br /> 103. BUSINESS SITE ADDRESS-Enter the street where the facility is luted,including building number,if applicablc.Post office box numbers are not acceptable
<br /> This information mmast provide a means to boats the facility geographically.
<br /> 104. CITY-Enter the city or unincorporated arca in which the facility is
<br /> 490.3a MONITORING EQUIPMENT IS SERVICED-Check theappropriatebox to specify theg/
<br /> 490-3b Slfy Older frequency for monitoring equipmentfrequ®noY off mot»todng aluiptxttt testis certification.
<br /> 490-4 SITE PLAN-Indicate if a site planlimp is submitted with this monitoring plan or if it was submitted Levi
<br /> a Site Piot P the tank and piping! afld the locations where mail � . t°�Y anted is curtest for the f�ility.Monitoring plans must invade
<br /> control panel,eta.), t6Tia8' Pefo�td(i.e.,location of probes,line leak detectors,monitoring system
<br /> 490.5 IV-i CONITMTOUS ELECTRONIC MONITORING-hWicate ifthis 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 secott
<br /> 490.7 PANEL MANUFACTURER--if IV-1 is checked,enter the name of the mornifitcuner of the monitorin �'containment.
<br /> MODEL#-If IV-i is checked,enter the model for the monitoring system control panelB system control panel(console).
<br /> .
<br /> 490.9 LEAK SENSOR MANUFACMMM-IfIV-1 is checked,enter the name of the ttrmwfactuter of the samor(s)If additional space is needed,use Section X.
<br /> 490-10 MODEL#(S)--IfIV-1 is checked,enter tte model number for each"of sensor insWIal.If additional space is needed,use Section X.
<br /> 490-11 IV-2 AUTOMATIC TANK GAUGING-Indicate ifthis is used for tie Ute•&
<br /> 4 -12 PANEL MANUFACTURER-IfIV-2 is checked.enter de ofthe ofthemonitoring system amtrol
<br /> 490-13 MODEL#-If IV-2 is chucked,enter the model number for the monitoring control panel.
<br /> panel(come)
<br /> 490.14 IN-TANK PROBE MANUFACTURER-IfIV-2 is checked,enter the now of the manufacul r of the probe(s).
<br /> 490.15 MODEL#(S)-IfIV-2 is checked,enter the model number for each tyle of in-tank probe installed.If additional space is
<br /> 490-16.LEAK TEST FREQUENCY-IfIV-2 is checked,chuck the appropriate box to describe the iratsnk leak test fregtuncy. wed,use Section X.
<br /> 490.17.SPECIFY-If490-16e is checked,enter the
<br /> 490-18.PROGRAMMED TESTS-IfIV-2 is odor frequency of i tests.
<br /> 490 19,SPECIFY-If 490-18c is �'chi the appropriate box Y0 be�t programmed into the ATG system.
<br /> checked,enter the fhequency of in-tank leak testing.
<br /> 490.20.IV-3 INVENTORY RECONCILIATION-Check the box ifstatisticai !memory reconciliation is performed.
<br /> 490-2I.IV-4 WEEKLY MANUAL TANK GAUGING. us
<br /> ifthis method is ed to monitor the tanks.
<br /> 490.22.TESTING PERIOD-IfIV-4 is checked,check the appropriate box to describe the MPG test
<br /> ng period.
<br /> 490.23.IV-5 TANK INTEGRITY TESTING:Indicate ifthis method is used to monitor the tanks.
<br /> 490-24.TEST FREQUENCY-IfIV-5 is checked,check the appropriate box to describe the
<br /> 490.25.OTT EER:If 490-24c is cluck of tank integrity testing,
<br /> ed,specify other test fraluerey_
<br /> 490.26.IV-99 OTHER:Indicate if monitoring of the tanks occurs cat is not indicated in any other
<br /> 490.27.IfIV-99 is checked,enter a brief n of t e other tank ) category.
<br /> 23CCR§2648). Include the method(s)I f) (e.g.,space umbo tore monitoring per 23 CCR¢2647,groundwater monitoring per
<br /> 490-28. div CO MONITOmmRING OF pIPE/P(IPING SUMPS)AND O EER SECCO ARY CONTAINMENT WITH AUDIS LE AND VISUAL ALARMS:
<br /> Indicate if this is the mooitorie�method used for the piping.
<br /> 490.29.SECONDARY CONTAINMENT:If V-1 is checked,Check the
<br /> appropriate 490.30.PANEL MANUFACTURER-If V-i is chocked,enter the name of the manufacturer o of the monitodn describe the envinment sande PiPin$secondary�ntaitnrum
<br /> 490-3I.MODEL#-If V-1 is clerked,enter rte model number for the monitor! g system control panel(console).
<br /> 490-32.LEAK SENSOR MANUFACTURER-If V-1 is checked,enter the name o system
<br /> control panel.
<br /> 490-33.MODEL#(S)-if V-1 is checked,enter the model number for each ofinstalled.If of thewndhcttffcr r(c
<br /> 490.34.PIPING LEAK ALARM T RIGGERS AUTOMATIC PUMPS WN-If V-1 isd,check space is needed,use Section X.
<br /> ea or No.
<br /> 490-35.FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN-If V-1 is checked,cluck Yes or No.
<br /> 490.36.V-2 PIPE MECHANICAL LINE LEAK DETECTORS PERFORM 3 OPH LEAK TESTS:indicate if this monitoring method is used c mom check
<br /> tic pilar No..
<br /> 490.37,MLLD MANUFACTURER(S)-If V-2 is checked,enter the names)ofthe manufaotu-(s)of du rmeolamdoai line leak
<br /> Section X. r(s).If additional space is needed,use
<br /> 490 38.MODEL#(s)-If V-2 is checked,Enter the model number for each of
<br /> irsichanical 490.39.V-3 PIPE ELECTRONIC LINE LEAK DETECTORS:Indicate if this monitoring duncod e!usedtoo= monitor tinstaheme if rnOHc space is needs!,use Becton X.
<br /> 490.40.ELLD MANUFACTURER-If V-3 is checked,Enter the of the man tectortes.
<br /> 490-41.MODEL#(S)n- If V-3 is checked,enter the model number for each of lite electronic tine leak detector ties.
<br /> appropriate
<br /> 490-42.PROGRAMMED LINE INTEGRITY TESTS If V 3 is c cluck Clea mniic lm�ne describe detector�led.if sly is use Section X.
<br /> 490-43.ELLD DETECTION OF A PIPING LEAK TRIGGERS PUMPS WNto_ type oftests programmed into the monitoring systeIfV_Im
<br /> 490-44,ELLD DETECTION OF A PIPING LEAK FAILURE 4DISCONNECTION TRIGGERS PUMP SMHDcbeckOWNYes
<br /> y I i Mcleoked,check Yes or No.
<br /> 49045.V-4 PIPE INTEGRITY TESTING-Indicate ifthis monitoring method is to monitor du i
<br /> 490-46.TEST FREQUENCY-If V-4 is clacked check the ate box to. be the p pd�s.
<br /> 490.47.SPECIFY-If 490.46-99 is clucked,enter the9neacY of Irk integrity testing
<br /> 490.48.V-5 VISUAL PIPE MONITORING �9 Y ofpi�itending,
<br /> - I if this monitoring method is used to monitor the pipelines.
<br /> 490.49.If V-5 is checked,cluck the appropriate sox to describe thetoncy
<br /> 490-50.SUCTION PIPING MEETS EXEMPTIONCRTTERIA_ Indicate mfttuos motritorinfvimW gi is esti to monitor the
<br /> 490 51.NO REGULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNECTED
<br /> Piping in the tank system is regulated under the UST law,or there is oro IVAIECTED TO THE TANK SYSTEM- Clack this box if no
<br /> 490-52.v-99 OTHER_Indicate if anodur method is used foeP
<br /> pipeline monitoring.
<br /> 490-53.SPECIFY-Enter a brief description of the other line monitoring methods)used. If additional space is see Section X. Be sure o clearly describe
<br /> monitoring method(s)and frequency.
<br /> This monitoring plan mat include a Site Pian showing the genera!task 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 d' (e.g.,current UST Monitoring Site Plan from a Monitoring System Certification form,Hazardous
<br /> Materials Business Plan map,etc.)that slows all required infwmation,include it with this plan.
<br /> UPCF UST-D(1212007)214
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