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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 Operating Permit
<br /> Application and within 30 days of changes in the information it contains. Please now that your local agency may require you to obtain approval prior to installing or
<br /> modifying monitoring equipment. (Note: Numbering ofthese 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 rovers all,or merely some,ofthe USTs at the facility. If the plan covers only some ofihe tanks,
<br /> identify those tanks in the space provided(e.g.,by using the Tank ID 0(s)in item 432 ofthe UST Operating Permit Application-Tank Information Form(s)].
<br /> I. 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,ifapplicable.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 /> 490-36 Specify Other frequency for monitoring equipment servicing.
<br /> 4904 SITE PLAN-Indicate ifa site pian/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 Plam/Map showing the tank and piping layouts and the locations where monitoring is performed(i.e.,location ofsemors,probes,line leak detectors,monitoring system
<br /> control panel,etc.).
<br /> 490-5 IV-I CONTINUOUS ELECTRONIC MONITORING-Indicate ifthis monitoring method is being used to monitor the tanks.
<br /> 490-6 SECONDARY CONTAINMENT-IfIV-1 is checked,check the appropriate box to describe the environment imide the tank secondary containment.
<br /> 490.7 PANEL MANUFACTURER--IfIV-1 is checked,enter the name of the manufacturer ofthe monitoring system control panel(console).
<br /> 490-8 MODEL q-IfIV-I 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 ofthe manufacturer ofthe sensor(s).If additional space is needed,use Section X.
<br /> 490.10 MODEL ff(S)--HIV-1 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 ifih(s method is used for monitoring the UST's.
<br /> 490-12 PANEL MANUFACTURER-IfIV-2 is checked,enter the name ofthe manufacturer ofthe monitoring system control panel(console).
<br /> 490.13 MODEL is-IfIV-2 is checked,enter the model number for the monitoring system control panel.
<br /> 490-14 IN-TANK PROBE MANUFACTURER-IfIV-2 is checked,enter the name ofthe manufacturer of the probe(s).
<br /> 490-15 MODEL 8(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 /> 490.16.LEAK TEST FREQUENCY-IfIV-2 is checked,check the appropriate box to describe the in-tank leak test frequency.
<br /> 490-17.SPECIFY-I17490-16e is checked,enter the frequency of programmed leak tests.
<br /> 490-I8.PROGRAMMED TESTS-If IV-2 is checked,check the appropriate box to describe the test programmed into the ATG system
<br /> 490-I9.SPECIFY-If 490-18c is checked,enter the frequency of in-tank leak testing.
<br /> 490.20.N-3INVENTORY RECONCILIATION-Check the box ifstatistical invemorymsumciliationisperformed.
<br /> 490.21.N4 WEEKLY MANUAL TANK GAUGING.Indicate ifthis method is used to monitor the tanks.
<br /> 490.22.TESTING PERIOD-IfIV4 is checked,check the appropriate box to describe the MTG testing period.
<br /> 490-23.IV-5 TANK INTEGRITY TESTING:Indicate ifthis method is used to monitor the tanks.
<br /> 490.24.TEST FREQUENCY-IfIV-5 is checked,check the appropriate box to describe the frequency oftank integrity testing.
<br /> 490-25.OTHER:I17490-24c is checked,specify other test frequency.
<br /> 490-26.IV-99 OTHER:Indicate if monitoring ofthe tanks me=that is not indicated in any other category.
<br /> 490-27.HIV-99 is checked.enter a brief description ofthe 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 ifthis 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 /> 490.31.MODEL q-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 more ofthe manufacturer of the smsor(s).
<br /> 490.33.MODEL ft(S)-If V-1 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 ifthis monitoring method is used to monitor the pipelines.
<br /> 490.37.MLLD MANUFACTURER(S)-If V-2 is checked,enter the names)ofthe manufacturet(s)ofthe mechanical line leak detector(s).Ifadditional space is needed,use
<br /> Section X.
<br /> 490.38.MODEL 8(s)-If V-2 is checked.Enter the model number for each type mfmechanical line leak detector installed If additional space is nmded,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 ofthe electronic line leak dewctor(s).
<br /> 49041.MODEL a(S)n- If V-3 is checked,enter the model number for each type ofelecironic line leak detector installed.Hndditionel 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 oftests programmed into the monitoring system.
<br /> 49043.ELLD DETECTION OF A PIPING LEAK ALARM TRIGGERS PUMP SHUTDOWN-If V-1 is checked,check Yes or No.
<br /> 490-44.ELLD DETECTION OF A PIPING LEAK FAILURF/DISCONNECIION TRIGGERS PUMP SHUTDOWN.-If V-1 is checked,check Yes or No.
<br /> 49045.V4 PIPE INTEGRITY TESTING-Indicate ifthis monitoring method is used to monitor the pipelines.
<br /> 490.46.TEST FREQUENCY-If V4 is checked,check the appropriate box to describe the frequency ofpipe integrity testing.
<br /> 49047.SPECIFY-If49046-99 is checked,enter the frequency ofpipe integrity testing.
<br /> 490-48.V-5 VISUAL PIPE MONITORING- Indicate ifthis mordtoring method is used to monitor the pipelines.
<br /> 49049.If V-5 is checked,check the appropriate box to describe the frequency ofvisual monitoring
<br /> 490.50.SUCTION PIPING MEETS EXEMPTION CRITERIA- Indicate ifthis 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 /> 49053.SPECIFY-Enter a brief description of the other line monitoring methods)used. If additional space is needed,sec Section X. Be sum to clearly describe
<br /> monitoring method(s)and frequency.
<br /> This monitoring plan most 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(122007)214
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