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01/31/2008 THU 15:44 FAX 209 83433 SJC EHD 0003/010
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<br />UPCF UST Monitoring Plan - Page 1 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
<br />Operating Permit Application and within 30 days of changes in the information it contains. Your local agency may require you to obtain approval
<br />yirior" to installing or 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
<br />the tanks, identify those tanks in the space provided [e.g., by using the'rank ID #(s) in item 432 of the UST Operating Permit Application - Tank Information
<br />Fonn(s)).
<br />t. 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
<br />acceptable. 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 a site plan/map is submitted with this monitoring plan or if it was submitted previously and is current for the facility. Monitoring
<br />pians must include a Site Plot Plan/Map showing the tank and piping layouts and the locations where monitoring is performed (i.e., location of sensors,
<br />probes, line leak detectors, monitoring system 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 - If i V-1 is checked, check the appropriate box to describe the environment inside the tank secondary containment.
<br />ti-I,:vi1tAC1 UKLK if IV -1 is checked, enter the name of the ruaaufacuucr of tine monitoring system control panei (console).
<br />490-8. M()DEL # - If IV -I is checked, enter the model number for the monitoring system control panel.
<br />490-9 LEAK SENSOR MANUFACTURER - If IV -1 is checked, enter the name of the manufacturer of the sensor(s). If additional space is needed, use Section X.
<br />490-10. MODFi, #(S) - ITIV-1 is checked, enter the model number for each type of sensor installed. If additional space is needed, use Section X,
<br />490-11 . tV-2 AUTOMATIC TANK GAUGING -Indicate if this method is used Tor 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 />490-1 i M401d . # - If 1 V-2 is checked, enter the model number for the monitoring system control panel.
<br />490-14. TN -TANK PROBE MANUFACTURER - IFIV-2 is checked, enter the name of the manufacturer of the probe(s).
<br />490-15. MODEL #(S) - IfIV-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-I0. LFAK TEST FREQUENCY - if IV -2 is checked, check the appropriate box to describe the in -tank leak test frequency.
<br />4c,()- i ; ;i'it('iFV "- ff 490-16e is checked. enter the frequency of programmed leak tests.
<br />490-1 n 1,I,0GRAMNILD TESTS - if 1V-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 IN'T'EGRITY 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: 117490-24c 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 methods) used (e.g., vadose zone monitoring per 23 CCR §2647, groundwater
<br />monitoring per 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 PIPEIPIPING SUMP(S) AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND VISUAi.
<br />ALARMS. Indicate if this is the monitoring method used for the piping.
<br />490-29. SECONDARY CONTAINMENT: If V -i 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 _> %. ODEL # - If V-1 is checked, cuter the model number for the monitoring system control panel.
<br />490-32 I ,FAK 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 cacti type ofsensor installed. If additional space is needed, use Section X,
<br />490-3-t PIPING LFAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN - if V-1 is checked, check Yes or No.
<br />45u n;i,URFAA,)CONNECION OF "THE; MONITORING SYS"ITM TRIGGERS AUTOMATIC PUMP SHUTDOWN - ff V-1 is checked, check Yes or No.
<br />490-3C,- V-2 PIPE: Ml?CHANICA. LINE LEAK DETECTORS PERFORM 3 GPFI LEAK TESTS: Indicate if this monitoring method is used to monitorthe pipelines.
<br />490-37. MLLD MANUFACTURERS) - If V-2 is checked, enter the name(s) of the manufacturer(s) of the mechanical line leak detector(s). if additional space is
<br />needed, use Section X.
<br />490-38 MODEL #(s) - If V-2 is checked, Enter the model number for cacti type of mechanical line leak detector installed. If additional space is needed, use Section
<br />X.
<br />490-39, V-3 Pi PE ELECTRON LINE LEAK DETF.C1'ORS: Indicate if this monitoring method is used to monitor the pipelines.
<br />490-40. Ef.I,D MANUFACTURER -- If V-3 is checked, Enter the name of the manufacturer of the electronic tine leak detector(s).
<br />490-41. MODEL #(S) - If V-3 is checked, enter the model number for cacti 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
<br />system.
<br />490-43, FLLD DETECTION OFA PIPING LFAK ALARM TRIGGERS PUMP SitUTDOWN - if V-1 is checked, check Yes or No.
<br />490-44, ELLD DETECTION OFA PIPING LEAK FAILURE/DISCONNi.:C'I'ION'rRIGGERS PUMP SHUTDOWN - If V-1 is checked, cheek Yes or No.
<br />490-45, V-4 PIPE IN'i-i?,GItl7'Y "TESTING - Indicate if this monitoring method is used to monitor the pipelines.
<br />490.46 TEST FRFQI JFNCY -- if V-4 is checked, check the appropriate box to describe the frequency of pipe integrity testing.
<br />49G ;PFCF',' ; I' P;O-4li �9 is checked, enter the frequency of pupa integrity testing.
<br />490-48 V-5 ViSIJAL 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 visuat 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 Iit:ALTTI AND SAFETY CODE, DIVISION 20, CHAP 'R 6.7 IS CONNI TI3D'1'0'I'IiE'rANKSYSTEM - Check
<br />this box if no 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 />Th;. ,..„„,;,,. n plan uau;st include a Site Plan showing the general tank and piping layouts and the locations where monitoring is performed (i.e., location of each
<br />sensor, Inc Irak detector, monitoring system control panel, etc.). if you already have a diagram (e.g., current UST Monitoring Site Plan from a Monitoring System
<br />Certification form, I Jami -does Materials Business Plan map, etc.) that shows all required information, include it with this plan
<br />UPC1, UST -D (12/2007) - 2/4 wovw.unidoes.org
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