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UP,
<br />Monitoring Plan - Page 1 Instructi
<br />Complete a separate UST Monitoring Plan for each UST monitoring system at the facility. This form must be submitted with your initial U$T
<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 />MOI. 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.ientifal
<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 />Ml 1. SECONDARY CONTAINMENT IS - Check the appropriate box to describe the environment inside tank secondary containment.
<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 -1 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
<br />M16. PANEL MANUFACTURER - If item IV -2 is checked, enter the name of the manufacturer of the monitoring system control panel (console).
<br />M17. 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 `IONITORING METHOD(S) - Check the appropriate box(es) in Section V to identify all required methods used for monitoringi ing int e
<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 -I is checked, enter the model number for each type of sensor installed. If additional space is needed, use Section IX.
<br />M36. WILL PIPMIG LEAK ALARM TR`GGER PUMP SHUTDOWN? - If item V-1 is checked, check Yes or No. or
<br />M37. WILL FAILUREMISCONNECT ION mV-2
<br />0is checked, SYSTEM name(s) TRIGGER the manufacturer(s)SHUTDOWN?
<br />OW- of theIf item V-1 is cal line leakdetector(s)., check YesNo. additional
<br />M38. MLLD MANUFACTURER(S) -
<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 IX.
<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 IX.
<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 />D - If item V-5 is checked, check the appropriate box to describe the frequency of visual monitoring.
<br />checked, enter a brief description of the other line monitoring method(s) used. If additional space is needed, use S
<br />M48. SPECIFY - If item RING ection
<br />M47. VISUAL MONITORING DONE
<br />DC. Be sure to clearly describe monitoring method(s) and frequency.
<br />This monitoring pian 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
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