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AUCs-21-2008 02:04 FROM:SCKAASF 209983-5394 70:2094683433 PAGE:06
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<br /> UST Monitoring Plan—Page 1 Instructions
<br /> C'omplChi a se.purate IJST M01140ring Plan for each U�'I' monitoring system at the facility. This toren Must bo submittec with your initial UST
<br /> t)p,:rutiug Permill Application and within 30 days of changes in the information it Wil in8, Please note that your local age-icy may require you to
<br /> uht,ain appt'r.eval rinr to FnSlaIIing or modifying monitoring equipment. (Note: Numbering or these instructions Hollows the dala element numbers oil
<br /> Ilic Rtrill.)
<br /> Mail, 'I YPI:(}F ACTION Check Ire:appropriate box to Indicate wiry this plan is being submitted.
<br /> MU!. PI-AN TYIT*-Check the appropriate haw la indicate whether this plan covers all,or merely some,ol'thc UST-,at the futility, If clic plan covers only
<br /> some of the ranks,identify I.hosu lacks in the space provided by using the Took ID#(s)in item 432 of the l.IS I'Operating Permit Application-
<br /> Tank Punn(s)l-
<br /> FAC'11,11'Y ID NUMBFR-This space is 1'or agency use only.
<br /> M(1.t. FACILITY NAME'-latwr the complete Facility Name.
<br /> Mtl.t. FACILITY SITE ADDRESS -F:nter the street address where the facility is located,including huilding number,il'upplic;iblc,fust ul'lice hex numbers
<br /> re 11411 acceptable. This irlkwiliation must provide a nrcuns to locale the facility geographically,
<br /> M(1:,, CITY Enter flu city or unincorporated area in which the facility is located.
<br /> Malo. MONITORIN(i EQUIPMENT IS SERVICE!)-Checked the appropriate box to specify the frctluency of monitoring equipment testiltg/CCPliliwtiun.
<br /> M11 . 5PJ:C'IFY- 11'item ll 99 is checked,enter the frequency of nlonitorinb equipment test ing/ccrtiIivation,
<br /> mIo. rANK MONITORING M[:9`HOU(S)-Check the appropriate boxes) in Section IV to iduntil'y all required talediods used for monitoring UST(s)
<br /> cnvcred by this plan.
<br /> MI 1. SFCONDARY CO'N'rA1NMF.N'f IS—Check the appropriate box to describe the environnient inside lank succ tadary containmCiti,
<br /> M 12. PAN1;,1.M A N t J FACTU RL'R-I r item IV-I is checked,enter the name of Che man uraclurcr of tate monitoring system cut ltrul paucl(Console).
<br /> M 11, Mi IA 1.4 1 I'item IV-I is checked,enter the model number for the monitoring system control panel,
<br /> M t 1. LEAK til?NS01(MANLJFA('"I'I JRFR -I P ilem IV-1 is checked,enter the nume of the manufacturer of the Sellsor(s).If udditie:ual space is needed,use
<br /> S+stivaa IX.
<br /> M l>. MODFI-ll(S) I f iters l V-1 is checked,caller the model number Air each type ul'sensor inStailad,If additional spa"is needud,use Section IX.
<br /> M10, PANE.MANUFAC H JRF.IZ-I f ilam 1 V-2 is checked,enter the name or the mamif tclurer of the monitornlg system control p i wl(cunsule).
<br /> MO. M(H)FL k-If hcria IV-2 is checked,enter thu model number rix the monitoring system control prate.
<br /> M I is. IN-TA NK PROBE MAN UFACTURLit-If item IV-2 is checked,enter the name of file manufacturer of the probe(s).
<br /> M 19. M(}I)I?l.ll($) I I nein IV-2 is checked,enter the model number for each type ul'in-funk probe installed.Iradditionul space is n_eded,use Swion FX.
<br /> M?o. iXAK'I EST FRFQtJENCY-If item IV-2 is Checked,check the appropriate box to describe the in-tank teak Lust frequency.
<br /> M'_'I. SPF,0 FY 1 r item lai is checked,enter the frequency of programmed Irak tests,
<br /> M22. PRO04AMMED TESTS-1r iteni IV-2 is chucked,check the appropriate box to describe the tests programmed into the A'f(a system.
<br /> M23. SPECIFY-IT iten)M22-c is checked,enter the frequency of io-tank leak testing.
<br /> M24. INVEN'roitY 1(LX_`0NCIt,IA'I'I0N- If item IV-3 is checked, check the appropriate box to describe the type of invcniAlry r,cuiiciliation perliirniud
<br /> (i.e.,Manual or Slatislicul).
<br /> M25, TEs,17I NG PERIOD-I f item I VA is checked,check the appropriate box to describe the MTC)testing period.
<br /> M26. I*I•:S'1'I'ItI;QI.1I"NCY II'itern IV-5 is checked,check the appropriate box to deseribu the frequency ortank hndgriry testing.
<br /> M27. SI'CCIPY ll'item IV-S C is Checked,entar the rreyuegcy of lank integrity testing.
<br /> M28. SPECIFY •If ilem IV-99 is checked,enter o brief description of the other lank monitoring methods)used(e,g„vaduse zone:nuniiorinb per 23 CCR
<br /> §2647,groundwater ni onihlring per 23 CCK§2648). Inc ludc the monitoring frequency(e,g.,Con(inuous,Weekly). (1'add'itioital space is needed,use
<br /> Sectiiin IX,
<br /> MSc} PIPF.MONITORING MF-I'HOD(S) Check the appropriate box(es)in Section V to identity ull required methods used fait'tltoniluring piping in the
<br /> US'I'systenl(s)covered by this plan.
<br /> M31 SECONDARY(:()N'I'AINMF NT IS •Check the appraprlaw bnx 1n describe the environment inside piping secundury tunlaialei vol.
<br /> M32 PANE'!,MANUFACI'URl_R -If item V-I is checked.enter the name of the manufacturer ofthe monitoring sysluna control pun,d(console).
<br /> M33 MODEL N-If item V-I is checked,enter the mode)number for the monitoring system control pastel.
<br /> Mad LEAK SENSOR MANUFACTURER- Iritem V-1 is checked,enter the name of the munulhcturer of the surisua{s).
<br /> M35 MO1)kl,A(S) if item V-t is checked,enter the model number(crouch type of sensor installed.If additional spgCe is nrudud,uw Section IX.
<br /> M34 WILL PIPIN(.i LEAK ALARM TRIGGER PUMP SHDTWWN?-If item V-I is checked,check Yes or No.
<br /> Mil Wl1,1,FAILUIt1JDISCONNF.f'!'ION OF MONITORING SYSTEM TKI(.10HR SHUTDOWN?-If item V-I is chuckWA check Yes or Nu.
<br /> Mat{ MILD MANI TACTURER(S)- If item V-2 is checked,enter the name(s)of the manufacturcrts)of the mechunical line leak alaeclor(s).If add ilionuI
<br /> -,puce is needed,use Section IX,
<br /> M39 MODI I.11(1)- If ilun V-2 is checked,enter the nit-idol nurnbar liar each type of mechaniea)line leak delectur installed. If uddilional space is needed,
<br /> use Secliun IX.
<br /> Mot) FLLD MANI II'A('Tl Ilil^ft iritent V-3 is checked,enter the name of the inanul'ucturer ofthe Metro niic line leak deteclor(s).
<br /> M4I Mt')I)li(,N(S) If item V-3 is checked,enter the model number for each type nfelectronic line leak detector installed.If addiliuilul space is needed,use
<br /> Section IX.
<br /> Mai PHOGRAMMED LINE INTF:(iRITY TESTS If item V-3 is checked,check the appropriate box to describe(Ile typu of lest>1 programmed into the
<br /> monitoring syslu 1,
<br /> Mc). WILL LLLD DE*I'HC'I'IUN OF A PIPING LEAK ALARM'I'RI00FR PUMP SHUTDOWN? lr item V-1 is checked,check Yes or Nn.
<br /> Mod. WII.I.FiLLn PAIL lRL)DISCONNF('110N TRIGGER PUMP SI IU.)OWN?-Ifitorn V-1 is checked,check Yes or No,
<br /> M45. TEST FRI`QIIE:NCY- If ilern V-4 is checked,check the appropriaw box ILI describe ails fregaency ot'pipQ integrity lusting.
<br /> Mdri 1%PIiCIFY V item V-4-c is checked,tatter Che frequency of pipe integrity testing.
<br /> M47. VISI JAI.MONI'I'OltING DONE • 1f item V-5 is checked,check the appropriate box it)describe the frequency elf visual atlouituring.
<br /> M48. SI'li('tFY I(item V-95► is checked,enter a hricf dose ripit ion cd-the other line monitoring meth r4(%)used, II'additional space is Heeded,use tieel ioII
<br /> IX. Be sure to clearly descrihc!Monitoring niethod(s)and frequency.
<br /> lass rlumitoring plan must include a Site Plan showing the general lank and piping layouts and the locations where niunituring is perfimned(ix., Incaliun of
<br /> each sensor, line leak tlelcelor, monitoring System control punct, etu.). If you already have a diagram (e.g., current UST Monitoring Site Plan from u
<br /> M,onimripg Sy%tun Certification(soma,I Iazardous Materials I3ugincm Plan map,etc.)which shows all required inihirm Ilion,include it v,ith this plan.
<br /> 3JCN'H D-rl(07NI3)-2/4 417/2:6/111
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