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UST Monitoring Plan - Page I 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 Form(s)].
<br />1. 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 box to specify the frequency of monitoring equipment testing/certification.
<br />490-3b Specify Other frequency for monitoring equipment servicing.
<br />490-4 SITE PLAN - Indicate if site plan/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 PlawMap showing the tank and piping layouts and the locations 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 if this monitoring method is being used to monitor the tanks.
<br />490-6 SECONDARY CONTAINMENT- IfIV- I 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 IV -1 is checked, enter the model number for the monitoring system control panel.
<br />490-9 LEAK SENSOR MANUFACTURER - IfIV-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) -- IfIV- 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 ifthis 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 - 117490-16e 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- I is checked, enter the name of the manufacturer of the sensor(s).
<br />490-33. MODEL #(S) - If V- I 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. FAILUREIDISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN - If V-1 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 - IfV-I is checked, check Yes or No.
<br />490-44. ELLD DETECTION OF A PIPING LEAK FAILUREIDISCONNECTION TRIGGERS PUMP SHUTDOWN. - If V-1 is checked, check Yes or No.
<br />49045. V4 PIPE DITEGRITY TESTING - indicate if this monitoring method is used to monitor the pipelines.
<br />490-46. TEST FREQUENCY -If V-4 is checked, check the appropriate box to describe the frequency of pipe integrity testing.
<br />490-47. SPECIFY - If 490-46.99 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 (12/2007) 2/4
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