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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 /> prior 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 Tank ID#(s)in item 432 of the UST Operating Permit Application-Tank Information
<br /> 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
<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 /> plans 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. W-1 CONTINUOUS ELECTRONIC MONITORING-Indicate if this monitoring method is being used to monitor the tanks.
<br /> 490-6. SECONDARY CONTAINMENT-If IV-I is checked,check the appropriate box to describe the environment inside the tank secondary containment.
<br /> 490-7. PANEL MANUFACTURER-If IV-I 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-If IV-I 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)-If IV-I is checked,enter the model number for each type of sensor installed.If additional space is needed,use Section X.
<br /> 490-11. W-2 AUTOMATIC TANK GAUGING-Indicate if this 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-If 490-16e 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. W-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
<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 PIPE/PIPING SUMP(S) AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND VISUAL
<br /> ALARMS: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-I 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-1 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-i is checked,check Yes or No.
<br /> 490-35. FAILURE/DISCONNECTION 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
<br /> needed,use 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
<br /> 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)-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
<br /> system.
<br /> 490-43. ELLD DETECTION OF A PIPING LEAK ALARM TRIGGERS PUMP SHUTDOWN-If V-i is checked,check Yes or No.
<br /> 490-44. ELLD DETECTION OF A PIPING LEAK FAILURE/DISCONNECTION TRIGGERS PUMP SHUTDOWN-If V-1 is checked,check Yes or No.
<br /> 490-45. V-4 PIPE INTEGRITY 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
<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 /> 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
<br /> sensor,line leak 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,Hazardous Materials Business Plan map,etc.)that shows all required information,include it with this plan.
<br /> UPCF UST-D(12/2007)-2/4 www.unidocs.org
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