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Mar 12 09 06:54p •- I pwren use ()uf}') Bi11's 76 This plan Local AeaAcY Stgirart+ro:. Cotmttenisorspecial Conditions: 2093671796 0 Approved With Conditions f ® Disapproved Date: _ a/ �� (.i �' •' UPCT UST Monitoring Pian - Page 2 Instructions p.7 ;Vi -a- t -m- -- ------------------- - - • ------------------------- e.hewhis pian. 490.54a. UDC MO` STORING METHOD(S) HODS) -Check the appropriate, box(es)to identify all required methods used (br• monitoring the area(s) beneath the dispensats). Check item 4MS4a-I if ;he UDC is monitored by a lea. sensor connected to a continuous monitoring console with wdi'blo aa4 visual alums. Check item 490-149-2 if the UDC is monitored by a mechanical davice that shuns the dispenser's shear valve when Equid in the UDC lifts a look detection float. Check item 490.549.3 if the UDC is monitored by a stand -anon. Icak smser that is not connected to a continuous monitoring console. If tic dispesisars are installed (c cut:rgehhcy generator tank system.X cheep item 490-54x-4 and skip to Schon VIL Cheep item 490444if die UDC is monitored by other methods. 490.346. SpSCIFY - Wit' 490-544-99 is checked, enters btiefou.-ription of the other = monitoring mellsod(s) used. If more spage is neptiloil, use Son= X. Be sae to clearly dostribc. monitoring snethod(s) and froquar y. 4MSS. i.EAIC MONITOR MANUFACTURER- If item 490 -54a -I is checked, tourthe tante of the mortifacturarof tx monitoring system control panel (console). 390.$6 MODS a - if ionto 490 544-1 is d"ed, enter the model muriLer for the monitoring system control Paul. 490-57. LEAK SS%SOR MAI U?ACCURER - If item 49(l -54a.1 or 4W54a-3 is checked, enter the name of the toamfacturer o: tiw se, sos(s)., If more space is ,aid, use Section X. 490-Sg. MOI)FL S(S) -If item 490.54a -i Or 490.54x3 is checked, ontorthe model number for each type ofsensor installed. if nota space is needed, use Saxion X. 490.59. WILL, v9TEM ION O%A LEAK INTO THE UDC TRIGGER AUDIBLE A\'D VISUAL ALAI&W. -Cl ack Yes orl�o. 490.60. WILL UDC LEAK ALARM TRIGGER PUMA SHUTDOWN? -Check Yes or No. 490dit. WILL FAILUREIDISCONNECTION OF UDC MONITORING SYSTEM TRIGGER SHUTDOWNP - Check Yes or No. 490.6:. WLLL UDC MONITORING EQUIPMENT STOP n1 S FLOW OF PRODUCT AT THE DISPENSER UPON LEAK DETECTION? - Cl=k Yes or No. 490.63. UDC CONSTR7XTION - Cheek the oppropriato bat to indicate whether the UDC has single wail or double wall consxsetsor Ifyou check item 490.63-I, "Lip to section Vll. 4MGRa. UDC INTERSTITIAL SPACE IS - If you ched, itean 490.63-2, ekack the appropriate box to describe the type of v*cuvWpreswreAydmstaiio (VPH) , o itoring ,provided for the UDC secondary containment. 490_64b. WILL Dz-TWTION OF A LEAK IN TIIE UDC INTERSTITIAL SPACE TRIGGER AUDIBLE AND VISUAL ALARMS? - If you check- heti 49"11-:, ibeckYe9crNo........................... ....................._..........._...................... VII. PER lolxc WSTEM TIESTIilG 49nd,S. ELD TESTING -Check this box if the SINRCB hos notified you that yon mors•, perform Ridggill Enhanced Leak Detection F3 D You do not need to check this box d! you tined to poefoma nae -time EI D tostiwy; dog, post-insatllation tostitrg) 4".M.. SECONDARY OONTAINMENT TESTil9G - You moat check this box slid provide patio4c ging if you have any UST system secondary conlairtmerd components that era not exempt from testing beonuso they aro monitored by a continuous vacwmlpressucolhydro is monitoring system - 490.05PIl;LBt K> ?,TF.S?I:tG,_ 1?ou trust cheek this box and ptoyido ennuat 4s'tinAOFAI .... ) UST flI spillbucksts.......................................... VIIt. ItEC65itD KEEPING 4904, %. M05j? I?4GihiJtT?4TL'_NANCE RLCQRDS - Check the ae"I ietc boxes to iaddeete UST roaotakt dept far the fiacilitl:...... ......................... •--......------------------------------- ..- - 1X.'fRA1lii10G 490.69. •(.'luck du tic for item 490 -Ma to indicate that prx3=W with UST menitoting rrsportsOS9litics are familia with :.do -ma reference documenm Check the ;tppropriau boxes for steins 490 -Ob through h to identity, mRmcc documents that arc maintained At the facility. Note that items 490.69b ane care anandatory. 490-69t SPECIFY - it item 490.69h is checked, enter a briefdosiv 1ption of ft aka rchrenhcc documents moinainorl at the faeil ity. 490.70. 1)r.S:GNATED UST OPERATOR - You must check this box and 1:ave ar least one Desigated UST Operator currently certified by ICC. Your Designated 1J51'Oprrator(s) must perform and doctament monthly visual hispccft of USl'systcrn compensate; aid Provide, required initial sect annual rofreshcrtraining Lor facihity�aaanncl._—__. _ ------------- _--____._—� X. CL)l4ttNl--N- fADDYrIONAL INFORMATION 490.71. i oa may use Will Ston to (10=iba Any additional UST system monitoring -related infortmatirm (e.g., additional information (squired by your local agary). ti' using Stenon X as additional space for' items loquimd clsewitemm in this plats, rcfcm= the item number (*,&, "item 490-33 - Model 2468 and 3579 Leak sensors"). X r SONNELRESPONSIBLUTLES 490.72. NAME - Fuer she name of 919 p.TM>5011 With telt•:'mataawltorky lbr performing the monitoring outivities and maintaining iraak detection equipment covered by this plan. If inure :#set one persalt has such authority, complete hem 493-74. 490-73. 'J1nV - Etter the title of the Feosol with ultimate t-Wiorwl for pert-omting the monitoring activity and maintaining leak• detection equipment covered by this plan. Iftoe than one person has such authordty, compile item 490.75. If not, skip to Section XII. 490-74. NM IE- Seo instructions for item 490.72. irmom than two people have such authority, now tot additional naana in sectiOrt X. 490-7S...'(aL-S a Ins:Egtj9gfg.rItonh4� 73.FfA.MtW_ ,AR9egplch9PRLgK490Zority,Ift,F 9sdditio5mlAa,�sisA ci% i ........................... XII 6WRERJOPeRA-r0R SIGNATURE The omterlopeator shall sip in th., space ptovided This signatur. certifies that the sign believes that all Infortnation Submitted is tm9, accurate, and complete. and that the training progrmn specified in Section IX has been implemaued ,L90.76. ItURESENTING - Check the appropriate box to indteate wheth9- the sigau is the UST ownerfoperator. the faciiity ownetfoperator, or an authorizes reiruaeenalim of the UST owner. 490.7?. DATE- Liar the Gate de plan %its signed. 490-78. APPLICANT NAME -Print or type the nonteoftheperson signhngthe plus. 480.74. APPLICANT TIIL� _Enorth9ti11t6ft.-eCsaisi�!'ist hcElaa�. UACIr UST -D (1°.J?.081) - 4J4 wu. mortmocs.org Eitbetive 01!17/08