|
UST Monitoring Plan-Page 1 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 Operating Permit
<br /> Application and within 30 days of changes in the information It contains. Please note that your local agency may require you to obtain approval prior to Installing or
<br /> modifying monitoring equipment. (Note: Numbering of these instructions follows the data element numbers on the form.)
<br /> 490-1. TYPE OF ACTION-Check the appropriate box to indicate why this plan is being submitted.
<br /> 490-2. PLAN TYPE-Check the appropriate box 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 Information Fotm(s)].
<br /> I. 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 locate 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 lox to specify the frequency of monitoring equipment testing/certification.
<br /> 490-3b Specify Other frequency for monitoring equipment servicing.
<br /> 4904 SITE PLAN-Indicate if a site pian/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 Dations where monitoring is performed(i.e.,location of sensors,probes,line leak detectors,monitoring system
<br /> control panel,etc.).
<br /> 490-5 IV-1 CONTINUOUS ELECTRONIC MONITORING-Indicate ifthis monitoring method is being used to monitor the tanks.
<br /> 490-6 SECONDARY CONTAINMENT-If IV-1 is checked,check the appropriate box to describe the environment inside the tank secondary containment.
<br /> 490-7 PANEL MANUFACTURER--If IV-1 is checked,enter the name of the manufacturer of the monitoring system control panel(console).
<br /> 490.8 MODEL#-If I V-I is checked,enter the model number for the monitoring system control panel.
<br /> 490-9 LEAK SENSOR MANUFACTURER-If I V-1 is checked,enter the name of the manufacturer of the sensor(s).If additional space is needed,use Section X.
<br /> 490.10 MODEL#(S)--If IV-I 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 used 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 panel(console).
<br /> 490-13 MODEL#-If IV-2 is checked,enter the model number for the monitoring system control panel.
<br /> 490-14 IN-TANK PROBE MANUFACTURER-If IV-2 is checked,enter the name of the manufacturer of the probe(s).
<br /> 490-15 MODEL#(S)-If IV-2 is checked,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 box to describe the in-tank leak test frequency.
<br /> 490-17.SPECIFY-If 490-16e is checked,enter the frequency of programmed leak tests.
<br /> 490-18.PROGRAMMED TESTS-If IV-2 is checked,check the appropriate box to describe the tests programmed into the ATG system
<br /> 490-19.SPECIFY-If 490-18c is checked,enter the frequency of in-tank leak testing.
<br /> 490-20.IV-3 INVENTORY RECONCILIATION-Check the box if statistical inventory reconciliation is performed.
<br /> 490-21.IV-4 WEEKLY MANUAL TANK GAUGING.Indicate if this method is used to monitor the tanks.
<br /> 490-22.TESTING PERIOD-If IV-4 is checked,check the appropriate box to describe the MTG testing period.
<br /> 490-23.IV-5 TANK INTEGRITY TESTING:Indicate if this method is used to monitor the tanks.
<br /> 490-24.TEST FREQUENCY-If IV-5 is checked,check the appropriate box to describe the frequency of tank integrity testing.
<br /> 490-25.OTHER:If 490-24c is checked,specify other test frequency.
<br /> 490-26.IV-99 OTHER:Indicate if monitoring of the tanks occurs that is not indicated in any other category.
<br /> 490-27.If IV-99 is checked,enter a brief description 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,use Section X.
<br /> 490-28. V-1 CONTINUOUS MONITORING OF PIPE/PIPING 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-1 is checked,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-1 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 RIGGERS AUTOMATIC PUMP SHUTDOWN-If V-1 is checked,check Yes or No.
<br /> 490-35.FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN-If V-I is checked,check Yes or No.
<br /> 490-36.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 manufacturer(s)of the mechanical line leak detector(s).If additional space is needed,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 /> 490.39.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 line leak detector(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 checked,check the appropriate box to describe the type of tests programmed into the monitoring system.
<br /> 490-43.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 No.
<br /> 490.45.V4 PIPE INTEGRITY TESTING-Indicate if this monitoring method is used to monitor the pipelines.
<br /> 490-46.TEST FREQUENCY-If V4 is checked,check the appropriate box to describe the frequency of pipe integrity testing.
<br /> 49047.SPECIFY-117490-46-99 is checked,enter the frequency of pipe integrity testing.
<br /> 490-48.V-5 VISUAL PIPE MONITORING-Indicate if this monitoring method is used to monitor the pipelines.
<br /> 490-49.If V-5 is checked,check the appropriate box to describe the frequency of visual monitoring.
<br /> 490-50.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 6.7 IS CONNECTED TO THE TANK SYSTEM- Check this 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 /> 490.53.SPECIFY-Enter a brief description of the other line monitoring method(s)used. If additional space is needed,see Section X. Be sure to clearly describe
<br /> monitoring method(s)and frequency.
<br /> This monitoring plan must include a Site Plan showing the general tank 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 diagram(e.g.,current UST Monitoring Site Plan from a Monitoring System Certification form,Hazardous
<br /> Materials Business Plan map,etc.)that shows all required information,include it with this plan.
<br /> UPCF UST-D(I ZA
<br />
|