COMPLIANCE INFO_2009-2018 - Laserfiche WebLink

Home Browse Search

(Agency(Ise Only) This plan has been revie Approved ❑Approved With CoA Local Agency Signature: Date: Comments or Special Conditions: UST Monitoring Plan—Page 2 Instructions Complete a separate UST Momtoring Plan for each UST monitoring system at the facility. This fi3nn must be submitted with your initial UST Operating Permit Application and within 30 days of changes in the iriffirmation it contains. Please;note that your local agency may require you to obtain approval V=to insta][ling or modifying monitoring equipment (Note: Numbering of these instructions follows the data element numbers on the form-) 490-54&MONITORING Of THE UNDER DISPENSER CONT AMMENT_ln icthe od used for UDC monitoring. 490-54b SPECIFY-If "Other"is checked,describe other method used. d ate meth If VI-1-t,VI-1-2OrVI-1-3 or VI-1-99 is checked,compkft490-55 to490-64b. 490-55 PANEL MANUFACTURER—Enter the time of the manufacturer of the monitoring system control panel(Console) If there is no control panel(e.g,only an electrical relay box is installed)leave this space blank. 490-56. MODEL#- Enter the model number for the mon'tonng system control panel(Console).Ifthere is no control panel(e g.,only an electrical relay box is installed)leave this space blank. 490-57. LEAK SENSOR MANUFACTURER—Enter the name of the munufheirner ofthe sonsor(s). 490-58. MODEL#(S)—Eriter the model number of the sensor(s)installed.Ifarlditimial space is needed,useX 490-59. DETECTION OFA LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL AL Section 490-60 UDC LEAK ALARM TRIGGERS PUMP SHUTDOWN- Indicate Yes or No [ndicate Yes or No 49061. FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN_Indicate Yes or No 490-62. UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER-Indicate yes or No. 49043' UDC CONSTRUCnON- Indicate iftlic Construction of the UDC is single-walled,or double-walled 4 9044a.DOUBLE-WALLED INTERSTITIAL SPACE MONITORING_ I"cat0 what isused fird i 490-64b.LEAK WITHIN ME SECONDARY CONTAIMENT OF UDC TRIGGERSftrsu Spam 490-65. VII-I ELD TESTING-Chock the box if you have been n AUDIBLE AND VISUAL ALARMS_Indicate Yes or No notified by the Stele Water Resources Control Board(SWRCB)that the UST(s)covered by this plan is/are WNW to Enhanced Leak Detection Requirements(ie.,UST has any 490-66. TESTING OF SECONDARY CONTAINMENT COMPONENTS E shWX-wall component and is located within 1,000 feet of public drinking water well). VERY 36 MONTHS-Check the box ifyou have secondary contairationt that requires testing, 490-67. SPILL BUCKET TESTING-Chock the box if you have soli buckets. 490-6ft h.VIII RECORDKEEPING-Indicate which monitoring and equipment maintenance records are mandamed 490-69a IX TRAINING STATEMENT-Check the box to verify that the statement is true, for this facility. REFERENCE DOCUMENTS MAINTAINED AT FACILITY—Check the appropriate boxes to describe reference docu first two items on the fist mug be kept at the facility. ments maintained at the facility. Note that the 49069b. MONITORING PLAN-Indicate that this plan is kept as a reference document 490-69C. OPERATING MANUALS FOR ELECTRONIC EQUIPMENT:Indicate that this plan is kept as a reference 490-69d. CA UST REGULATIONS-Indicate d1at this is kept as a reference document document. 490-69e. CA UST LAW-Indicate that this is kept as a reference document 490-CM,STATE WATER RESOURCES CONTROL BOARD(SWRCB)PUBLICATION -Indicate reference STATISTICAL INVENTORY RECONCILIATION _ "HANDBOOK FOR TANK OWNERS-MANUAL AND 4 e that this is kept as a ref ce document 9"99-sWRCB PUBLICATION "UNDERSTANDING AuTomA*ncTANK GAUGING sySTEw: 490-69h.UMER-Indicate that other reference documents am kept. Indicate that this is kept as a reference document, 490-,(M- SPECIFY-If"OTIMEr is checked,enter a bT!cfdcscdPtim of the other documenKs)maintained at t facility.Ifaddi mal s 490-70- DESIGNATED OPERATOR TRAINING he 64 pace is needed,me Section X 490-71, COMMENTS/ADDITIONAL INFO RMA-Check this box to verify that ft,statement is true. 11ON—Make additional comments or you may attach and identify the number ofarlditional pages of information to describe any additional UST sygent monit0fing-related infiumation(e.g.,addition infbrr�on required by your local agency). Attach any monitoring logs that you will be using for the monitoring of your tank systAm at 490-72. NAME—Enter the name of the person who routinely conducts the monitoring and a* t 490-73. TITLE- Enter the title of the pez"L Pmoa amintenance under this plan. 49074 NAME—Enter the name of the second person,ifaPplicable,who routinely conducts pment enance under this plan490-75. TITLE- Enter the tide of the second pawn. the monitoring and aqui mains OWNERIO PERATOR SIGNATIJRE—The tank ownerlope"t0r,facility r! or,or an audwized representmive of This signal=certifies that the Signer believes that all information submitted the Owner ball sign in the SP0CC provided been implemented, is true,accurate.and Complete.and that the training program specified in Section IX has 49076- REPRESENTING—Check the appropriate box to'nd""de whether the signer is the LIST owner-/Cperator�the UST facility owner/operator, authorized representative of the owner. or an 49077. DATE—Enter the date the plan was signed. 49078. APPLICANT NAME—Print or type ate name Of the Person signing the plan. 4M79. APPLICANT TITLE—Enter Me fitle of the person signing am plan. UPCF UST-D(12r2007)4/4