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1pA. Monitoring Plan -. Page 1 Instructio
<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 damson changest the equipment (ote:oNumbering of these instructions fcontains. please note that ollows the data element local agency may numbers on
<br />uire you to
<br />obtain approval prior to installingor modifying g q P �
<br />the form.)
<br />MOI.
<br />M02.
<br />M03.
<br />M04.
<br />MOS.
<br />M06.
<br />M0T
<br />MIO
<br />TYPE OF ACTION - Check the appropriate box to indicate why this plan is being submitted -
<br />PLAN TYPE -Check the appropriate box h indicate whether� Plante thers all,
<br />ID #(s) in item 432 of the or merely some, of the USTs UST Operating Pthe facility. If ermit Application Y
<br />some of the tanks, identify those tanks in the space pro g•> by B
<br />Tank Form(s)].
<br />FACILITY ID NUMBER -This space is for agency use only.
<br />FACILITY NAME - Enter the complete Facility Name.
<br />FACILITY SITE ADDRESS - Enter the street address where the facility is located, iincluding bbuilding number, if applicable. Post office box numbers
<br />are not acceptable. This information must provide a means to locate the facility geographically.
<br />CITY - Enter the city or unincorporated area in which the facility is located. the frequency of monitoring equipment testing/certification.
<br />ED - Checked the appropriate box to specify-
<br />MONITORING EQUIPMENT IS SERVIC
<br />SPECIFY - If item II -99 is checked, enter the frequency of monitoring equipment testing/certification.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. o ate box to describe the environment inside tank secondary containment.
<br />SECONDARY CONTAINMENT IS - Check the appropriate
<br />ppy pri stem control panel console
<br />PANEL MANUFACTURER - If item IV -1 is checked enter the name of the manufacturer oCO tifothpanmonit°ring system P (console).
<br />MODEL # -If item IV -1 s checked, enter the model number for the monitoring system
<br />ENSOR MANUFACTURER - If item IV -1 s checked, enter the name of the manufacturer of the sensor(s). If additional space s needed use
<br />Mil.
<br />M12.
<br />M13.
<br />M14.
<br />MI5.
<br />M16.
<br />MIT
<br />M18.
<br />M19.
<br />M20.
<br />M21.
<br />M22.
<br />M23.
<br />M24.
<br />LEAK S
<br />Section IX. of sensor installed. If additional space s needed, use Section IX.
<br />MODEL #(S) - If item IV -1 s checked, enter the model number• for each type stem control panel (console).
<br />PANEL MANUFACTURER - If item IV -2 is checked, enter the name of the manufacturereP° tong s'
<br />MODEL # - If item IV -2 s checked, enter the model number for the monitoring system
<br />of m -tank probe installed. If additional space is needed, use Section IX.
<br />IN -TANK PROBE MANUFACTURER - If item IV -2 is checked, enter the name of the manufacturer of the pro s .
<br />MODEL #(S) - If item IV -2 s checked, enter the model number for each iate type ox to describe the- leak test frequency.
<br />Pn
<br />LEAK TEST FREQUENCY - If item IV -2 s checked,cheo the aPPr leak tests.
<br />SPECIFY - If item M20 a is checked,enter the frequency programmed box to describe the tests Programmed into the ATG system.
<br />ate
<br />PROGRAMMED TESTS - If item IV -2 s checked, check the appropn
<br />d, enter the frequency of in -tank leak testing. box
<br />INVENTORY RECONCILIATION - to describe the ripe of inventory reconciliation perforated
<br />SPECIFY - If item M22 -c s checkeIf item IV -3 is checked check the appropriate
<br />(i.e., Manual or Statistical). ate box to describe the MTG testing period.
<br />TESTING PERIOD - If item IV -4 is checked check the appropriate ofd integrity testing.
<br />TEST FREQUENCY - If item IV -5 is checked, check �the Oftankgrity testing. opriate box to describe the frequency
<br />SPECIFY - If item IV -S -c s checked, enter the frequency used (e. vadose zone monitoring per 23 CCR
<br />per 23 CCR §2648d Include the monitoring frequency (e.g., Continuous, Weekly). If additional space is needed, use
<br />SPECIFY - If item IV -99 s checked, enter a brief description of the other tank monitoring methods g•�
<br />§2647, groundwater monitoring p in the
<br />IX In Section V to identify all required methods used for monitoring Piping
<br />M25.
<br />M26.
<br />M27.
<br />M28.
<br />Section Check the appropriate boxes)
<br />M30. PIPE MONITORING METHODS) -
<br />UST system(s) covered by this plan
<br />IS -Check the appropriate box to describe the environment inside piping secod control ry panel(console).
<br />ent
<br />M31. SECONDARY CONTAINMENTIf item V-1 is checked, enter the name of the manufacturer of the monitoring system
<br />M32. PANEL MANUFACTURER -r for the control panel.
<br />M33- MODEL # - If item V-1 F checked, enter �� del V-1 s cheeccked, enter the name off the manufacturer of the sensor(s).
<br />M34. LEAK SENSOR MANUFACTURE enter the model number for each type of sensor installed. If additional space s needed, use Section IX.
<br />M35. MODEL #(S) - If item V-1 is checked, check Yes or No.
<br />M35. WILL PIPING LEAK ALARM TRIGGER PUMP SHUTDOWN? - If item E S SHUTDOWN? - If item V-1 is checked, check Yes or No.
<br />M37. WILL FAIL URE/DISCONNECTION OF MONITORING SYSTEM TRIGGER SHUTDO
<br />M3g WILL
<br />Lp MANUFACTURER(S) - If item V-2 is checked, enter the name(s) of the manufacturers) of the mechanical line leak detector(s). If additional
<br />cal line leak detector installed If additional space is needed
<br />space is needed, use Section IX. enter the model number for each type of mechani
<br />M39. MODEL #(s) - If item V-2 s checked,
<br />use Section IX.
<br />checked, enter the model number for each type of electronic line leak detector installed. If additional space is needed, use
<br />M40. ELLD MANUFACTURER � chtem V-3 s checked, enter the name of the manufacturer of the electronic line leak detector(s)-
<br />use
<br />etecto s .
<br />M41. MODEL #(S) - If item V of tests programmed into the
<br />Section IX. INTEGRITY TESTS - If item V-3 is checked, check the appropriate box to describe the type P
<br />M42. PROGRAMMED LINE INTE
<br />monitoring system. TRIGGER PUMP SHUTDOWN? - If item V-3 is checked, check Yes or No.
<br />ISCONNECTION TRIGGER PUMP SHUTDOWN? - If item V-1 s checked, check Yes or No.
<br />M43. WILL ELLD DETECTION OF PIPING LEAK ALARM ro nate box to describe the frequency of pipe integrity testing.
<br />M44. WILL ELLD FAILURE/D
<br />M45. TEST FREQUENCY - If item V 4 s checked, check the app i p integrity testing en of usual monitoring.
<br />M46. SPECIFY - If item V -4-c is checked enter the frequency pipe box to describe the ) use frequency
<br />methods) used. If additional space is needed, use Section
<br />M47 VISUAL MONITORING DONE -If item V-5 -- checked check the appropriate
<br />M48. SPECIF - If item V_99 is checked, enter a to clearly describe monitoring metrief sand frequenccription of y. °�� tine monitoring
<br />1X Be s performed (i,e., location of
<br />Plan must include a Site Plan showing the general tank and piping layouts and the locations where monitoring is p i
<br />This monitoring p stem control panel, etc.). If you already have a diagram (e.g., current UST Monitoring Site Plan from a
<br />each sensor, line leak detector, monitoring system
<br />an map, etc.) which shows all required information, include it with this Plan.
<br />Monitoring System Certification form, Hazardous Materials Business PI
<br />07/23/03
<br />SJCEIID-d (07/03) - 2/4
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