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uAlkMonitoring Plan-Page 1 InstructiadlL
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<br /> Complete'a separate.-UST Monitoring Plan for each UST monitoring system at the facility. This form must be submitted with your initial UST
<br /> Operating Permit Application and within 30 days of changes in the information it contains. Please note that your local agency may require you to
<br /> obtain approval prior to installing or modifying monitoring equipment. (Note: Numbering of these instructions follows the data element numbers on
<br /> the form.)
<br /> Mol. TYPE OF ACTION-Check the appropriate box to indicate why this plan is being submitted.
<br /> M02. 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
<br /> some of the tanks,identify those tanks in the space provided[e.g.,by using the Tank ID#(s)in item 432 of the UST Operating Permit Application-
<br /> Tank Form(s)].
<br /> FACILITY ID NUMBER-This space is for agency use only.
<br /> M03. FACILITY NAME-Enter the complete Facility Name.
<br /> M04. FACILITY SITE ADDRESS-Enter the street address where the facility is located,including building number,if applicable.Post office box numbers
<br /> are not acceptable. This information must provide a means to locate the facility geographically.
<br /> M05. CITY-Enter the city or unincorporated area in which the facility is located.
<br /> M06. MONITORING EQUIPMENT IS SERVICED-Checked the appropriate box to specify the frequency of monitoring equipment testing/certification.
<br /> M07. SPECIFY-If item II-99 is checked,enter the frequency of monitoring equipment testing/certification.
<br /> M10. TANK MONITORING METHOD(S)-Check the appropriate box(es) in Section IV to identify all required methods used for monitoring UST(s)
<br /> covered by this plan.
<br /> M11. SECONDARY CONTAINMENT IS-Check the appropriate box to describe the environment inside tank secondary containrrrent.
<br /> M12. PANEL MANUFACTURER-If item IV-1 is checked,enter the name of the manufacturer of the monitoring system control panel(console).
<br /> M13. MODEL#-If item IV-1 is checked,enter the model number for the monitoring system control panel.
<br /> M14. LEAK SENSOR MANUFACTURER-If item IV-I is checked,enter the name of the manufacturer of the sensor(s).If additional space is needed,use
<br /> Section IX.
<br /> M15. MODEL#(S)-If item IV-1 is checked,enter the model number for each type of sensor installed.If additional space is needed,use Section IX.
<br /> MI6. PANEL MANUFACTURER-If item IV-2 is checked,enter the name of the manufacturer of the monitoring system control panel(console).
<br /> MIT MODEL#-If item IV-2 is checked,enter the model number for the monitoring system control panel.
<br /> M18. IN-TANK PROBE MANUFACTURER-If item IV-2 is checked,enter the name of the manufacturer of the probe(s).
<br /> M19. MODEL#(S)-If item IV-2 is checked,enter the model number for each type of in-tank probe installed.If additional space is needed,use Section IX.
<br /> M20. LEAK TEST FREQUENCY-If item IV-2 is checked,check the appropriate box to describe the in-tank leak test frequency.
<br /> M21. SPECIFY-If item M20-e is checked,enter the frequency of programmed leak tests.
<br /> M22. PROGRAMMED TESTS-If item IV-2 is checked,check the appropriate box to describe the tests programmed into the ATG system.
<br /> M23. SPECIFY-If item M22-c is checked,enter the frequency of in-tank leak testing.
<br /> M24. INVENTORY RECONCILIATION-If item IV-3 is checked,check the appropriate box to describe the type of inventory reconciliation performed
<br /> (i.e.,Manual or Statistical).
<br /> M25. TESTING PERIOD-If item IV-4 is checked,check the appropriate box to describe the MTG testing period.
<br /> M26. TEST FREQUENCY-If item IV-5 is checked,check the appropriate box to describe the frequency of tank integrity testing.
<br /> M27. SPECIFY-If item IV-5-c is checked,enter the frequency of tank integrity testing.
<br /> M28. SPECIFY-If item IV-99 is checked,enter a brief description of the other tank monitoring method(s)used(e.g.,vadose zone monitoring per 23 CCR
<br /> §2647,groundwater monitoring per 23 CCR§2648). Include the monitoring frequency(e.g.,Continuous,Weekly). If additional space is needed,use
<br /> Section IX. piping M30. PIPE MONITORING METHOD(S)-Check the appropriate box(es)in Section V to identify all required methods used for monitoring
<br /> in the
<br /> UST system(s)covered by this plan.
<br /> M31. SECONDARY CONTAINMENT IS-Check the appropriate box to describe the environment inside piping secondary containment.
<br /> M32. PANEL MANUFACTURER-If item V-1 is checked,enter the name of the manufacturer of the monitoring system control panel(console).
<br /> M33. MODEL#-If item V-1 is checked,enter the model number for the monitoring system control panel.
<br /> M34. LEAK SENSOR MANUFACTURER-If item V-1 is checked,enter the name of the manufacturer of the sensor(s).
<br /> M35. MODEL#(S)-If item V-1 is checked,enter the model number for each type of sensor installed.If additional space is needed,use Section IX.
<br /> M36. WILL PIPING LEAK ALARM TRIGGER PUMP SHUTDOWN?-If item V-I is checked,check Yes or No.
<br /> M37. WILL FAILUREIDISCONNECTION OF MONITORING SYSTEM TRIGGER SHUTDOWN?-If item V-I is checked,check Yes or No.
<br /> M38. MLLD MANUFACTURER(S)-If item V-2 is checked,enter the name(s)of the manufacturer(s)of the mechanical line leak detector(s).If additional
<br /> space is needed,use Section IX.
<br /> M39. MODEL#(s)-If item V-2 is checked,enter the model number for each type of mechanical line leak detector installed.If additional space is needed,
<br /> use Section DC.
<br /> M40. ELLD MANUFACTURER-If item V-3 is checked,enter the name of the manufacturer of the electronic line leak detector(s).
<br /> M41. MODEL#(S)-If item V-3.is checked,enter the model number for each type of electronic line leak detector installed.If additional space is needed,use
<br /> Section DC.
<br /> M42. PROGRAMMED LINE INTEGRITY TESTS-If item V-3 is checked,check the appropriate box to describe the type of tests programmed into the
<br /> monitoring system.
<br /> M43. WILL ELLD DETECTION OF A PIPING LEAK ALARM TRIGGER PUMP SHUTDOWN?-If item V-3 is checked,check Yes or No.
<br /> M44. WILL ELLD FAILURE/DISCONNECTION TRIGGER PUMP SHUTDOWN?-If item V-1 is checked,check Yes or No.
<br /> M45. TEST FREQUENCY-If item V-4 is checked,check the appropriate box to describe the frequency of pipe integrity testing.
<br /> M46. SPECIFY-If item V-4-c is checked,enter the frequency of pipe integrity testing.
<br /> M47. VISUAL MONITORING DONE -If item V-5 is checked,check the appropriate box to describe the frequency of visual monitoring.
<br /> M48. SPECIFY-If item V-99 is checked,enter a brief description of the other line monitoring method(s)used. If additional space is needed,use Section
<br /> DC. Be sure to clearly describe 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
<br /> each sensor, line leak detector, monitoring system control panel, etc.). If you already have a diagram(e.g., current UST Monitoring Site Plan from a
<br /> Monitoring System Certification form,Hazardous Materials Business Plan map,etc.)which shows all required information,include it with this plan.
<br /> 07/23/03
<br /> SJCEHD-d(07/03)-2/4
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