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06,104/2009 08:39 2098585066 TWO GUYS FOOD PAGE 05/05
<br /> � U9'i'Mnnilor:ng Plan-Prm41 Inalewdionx
<br /> Complete a separate UST Monkndng Plan for each UST monitaieg syslom at the facility. 'rbc form most be smemktod with,your initial UST Operating Permit
<br /> Applicatinn and within 30 days al changes In,the information it cnnfain, Flame note mat your local ameriey may require you to obtain approval prior to inmallirm Or
<br /> modifying mnobating equipment. (Nota: Numbering of Ibale.Ini retiom follows me data dement number on(be Corm.)
<br /> 490-I. T'YrF OF ACTION (:heck due appropriate box to Ilnlicale why this plan is tieing.mbmikal,
<br /> 490.2. PLAN TYPE..Chcak the appropriate box to indicate whdher this plan coven,all,or merely same,of the UATs at the facility. Iflleplatiwcm onlysumeafthabaNa,
<br /> idrngfy thave tank is the mrncc provided[0-g.,by unng rark,I D ff(s)in Ivan 432 or d,e LIST Gpcmting Perrot Appliention-lank Informal Fann(s)l.
<br /> I. FACILITY IUNIIMRPK-Thisspwciafoeug�v yl-I'n1y,
<br /> 3. RIISINESSNAME- Fnarthecomploc FacilityNane.
<br /> 103. BUSINESS SITE A.DUR555-Entatlne shat addive whom the iiciliq is locafchL incivdirg lndlding enunba,if,q,plicnble.Post altice bnz unmban are nm aaxPrnMe
<br /> This bdormmion mml Provide a means to locate the facility genlpnpbiolly.
<br /> 104. CITY-Enter the city or.mincomornhd area hl,vhid,the Imlay is located.
<br /> 490-3n MONITORING EQUIPMENT IS SPRVICED-Check thoapanrlainte box IO Opacify the tranteney nr monitoring Wttirment laatingIcartatemlan.
<br /> 490-31, Specify Wer fnamnney for monitoring cquiPmcut servicing.
<br /> 4904 SITE PLAN-Indiana ifn sire plan/map is snbmivai with this manitoring plot,ne ifit ens nubmktal pmv;misly and is current inrthc im0iq.h1imihaing phos most Include
<br /> a Siie Plot Plan/Map showing the tankmld piping Kama amt dw lenkma where mounting ni'nrrmrrncd(ire.,Incadon of sannR pmbea,IMe leak daeclom,monitaing;",or
<br /> wnval Imnd,dc).
<br /> 490.5 1V.1 CONTINUOUS PI,PLTRONIC MONITOKIN(i•ladicare Krhu wiliruring method is being used m manimr rhe banks.
<br /> 490.6 SECONDARYCYINTAIN.MENT- Ifly-lis rA,eckcd,check The oppmpa4me hew to describe Orae avinaimrm inside the banksecundmy eantimacnt
<br /> 490-7 PANELMANUFACTURFA Ifiv,l is cbecked,cmcr the mine oftho mmmtfacmta ofthe madtaring system control panel(comalc).
<br /> 490.9 MODELI/ .Iffy-I ischecked.tionthe rmrdel rumba fa die=114onuS saM Contmlpanel.
<br /> 4911-4 LEAK SENSOR MANUFACILILRR-IfIV.l is ehreked.eatathc name afihe mans Gromrer of thesrn%this),IFaddi6;nal space in neednL uze Scetinn X.
<br /> 490-10 MODEL U(S) ..If IV-1 in clacked,Oita this rurelel nomher for each type ofic sot insmllal.LfadNliuml Vwc is medal,me R«drn X
<br /> 440-11 IV-2 AU'G/MATIC TANK GAUGING.Lndiale if dos method is recd for monibr op;the UST'n.
<br /> 4911.12 PANEL MANIIFACTUAER-U LV-2 Lr cliecko4 enter the nmmc afthc manufndnrcr nine monilaing systmn aomml panel(masala),
<br /> 49(1.13MODELP 1r IV-2in ,bmkcd,triter die initial number for the monitoring synlcm mmemi poneL
<br /> 49044 JWTANK PROBE MANUFAC-1`1191IR-Ifi V-2 is checked,enter dm name of the mmmfxm,v of the Frabc(n).
<br /> 490.15 MOOPL p(S)-If IV-21.s checked,Otter the model number for each"of in-tank probe m4allnl,tf additional space in needed,rine Section X
<br /> 490.16.LPAK TEST FREQUEN47-If IV•2 in checked.check Ila appmprime box to describe die in ark Irak tont Ocgrnacy.
<br /> 490-17.SPECIFY-hr440.1(,r.is checked,anter we Roquoncy of pmgmmmcd lark teat%.
<br /> 49NI8.PROCr.RAMMPD T'F-S'IS-IflV-24 chocked,check theappropriate box lin dexenbe thetemp ptagea anal into the xro-,ydem,
<br /> 4911-14.RPP,CIFY-If 490-IRc i.chxkcd,rnter the Ocgrua,q nfinrmk Ienk Leming
<br /> 49(1.20,IV-3lNVENIL)RYRECONCILIATION- C7wek Wehrwifsmtimieal Mvrniory rmmcilimion ie peefi,emal,
<br /> 490.21.IVA WEEKLY MANUAL TANK GAUOING,Indicate ifthis method Ls used to monitor the banks.
<br /> 490.22.TES71NO PERIOD-If IVA 1%dteekvl,cheek the appropriate box to dos rhe he MTG tcrtlhg perm{.
<br /> 490.23.1 V-5 TANK INTPGRITY TESTING:mdjer.if illi%method is used to motalm the mks,
<br /> 4911.24.TEST FREQUENCY-if IV-5 in;cicAod,check rhe appropriate box 0 dcunhe the fregneney of Lank inmgnty,testing.
<br /> 490.25.OTHPk,if 490.244 is checked,specify other n,4 Oequancy.
<br /> 490.26.IV-99 OT14EIL ladinma ifmon Loring of dee bank o cim then is not indianod in any rather entegory.
<br /> 490.27.If I V-99 is cimkw4 inner a bdof doacdption of the odtm lark monimdng mcthod(s)oral(e,g„wrlasc vim:movitmiam par 23 CCR 42647,gmnndn�nta mrmitmin i per
<br /> 23CCR 4264&). lulude the monitoring frognrncy(u.g..(:maimimin.Wcckly). Ir mklitinnnt spmc in necdo d,uw Ssrxinn X,
<br /> 490-2R. v-1 CONTINUOUS MONITORING OF PIPFJAVIN(t SUMP(S) AND OTHER SECONDARY CONTAINMRNT WITH AUOIB LP. AND VISUAI. ALARMS:
<br /> indicate ifdd.s is the monitoring methodused far thc Pring
<br /> 490-29,SECONDAItY CONTAINMENT!1f V-1 N eta s'l,Check the appropriate bon w drwnbc the orivimnmad inside pining accoml:ny cnnmipmem.
<br /> 4WI(I.PANEL MANUFA(7URER-U V-1 Is ehcckcd.rnhr iha nmmc of rhe mmmf emnr ariryc monilonng system comm/panel(am%nuc),
<br /> 490.31.MODEL 11-IfV-1 is checked.enter the mmiel mrnba for the monitoring%ystem damn/panel.
<br /> 490.32.LEAK%NSOR MANUFACfUR5R-If V-I is reeked.Oita the name of rhe manufacturer ordsa scnsor(s)•
<br /> 490-33.MODEL M(S)-If V-I in eheckal,-m the model number Iter such typo ofscmar aniallttL IFatditionN space Ls ne cdod,,ac Section X.
<br /> 490.34,PIPING LEAK ALARM.T RIGGSP.S AUTOMATIC PUMP SHUTDOWN -IfV-1isehcckal,chock Yesor No.
<br /> 490-35.FAILUREMISCONNP,CTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SI n1Trl0 WN-If V-1 is cheekM,check Yos m No
<br /> 49036.V.2.PIPE MECHANICAL LINE LEAK Dtil'EC'r0RS PPRFORM 3 GPH LEAK'rFRTS;Indictee If this mameming method 6 meat in moults flit Pipelines,
<br /> 490,37.MLI,D MANUFA(7rURER(S)-UV-2 in checked.anal thc Panels)ofthe mmatrtehnrcr(n)of the mcchimicnl lira look derecmt(s).U aiditionnl apo n is pealed,nue
<br /> Section X
<br /> 490-3R.6tODPL II(s)-UV4 is duakad,Enter the model amnbcr fix coeb type of mechmntcal tine hark deteclot Installed.Ifadditional spn;c is needed,into Section X.
<br /> 490-39.V.31MP13 ELECTRONIC LINE L"K.DETECTORS:billion:if Nis mmtiloring method ix nsal to monitor the pl islihes,
<br /> 49040.FLIM MANUFACTURER-If V-3 is checked.Enter die name of flit manufaaumr of the electronic line lack ddednr(s).
<br /> 490.41.MODEL fl(S)n. ICVet is checked,enter the nealcl rumba for awl type ardec , is line leakdaccurc installed.Ifaddition:dspacc in needed,use$.flonX
<br /> 490.42,PROGRAMMED LINE INTBORITY TU$75 41'V-3 is chocked,check the appropriate box to dascrih,the type of ION pmgmmmed into die mnnimring system.
<br /> 49043.ELLD DETECTION OF A PIPING LEAK ALARM TRTOGERS PUMP SHUTDOWN-If v-I E diecknL cluck Yen or Nu.
<br /> 4%44.ELT-D DETECTION Or A PIPING LEAK FAILURVOTSCONNECTION TRIGGBRS PUMP SHUTDOWN,-If V-1 la checked,check Yes ur No.
<br /> 49045.V-0 PIPE INTFGRI"rY TPSTING-Indiate if this mrmikwing mahol is itsod Lo Immunrtha pipelines.
<br /> 49046.TEST FREQUENCY-I rv4 in deckccL check the aPPmPnara box to describe dna fgnency of pity;hncgnty tending•
<br /> 49Nt7,SPECIF'Y If490.46-99 Is Clux:kaL erathe fiolnrnry pfpipeinlegriNf Nt.
<br /> 4WWA,V-5 VISUAL.PIPS MONITORING- Indicate ifthis monitoring method 1%rased to monitor the piralincs.
<br /> 49(I-09,If V-5 le th,xked,check Mc NRvrpniate hnx m desaibc the frcgnaley of vimni monitoring.
<br /> 490.50,SUCTION PIPING MEETS EXEMFTI0N CRITERIA- ludicme i71h(x,mmimnng mMod is usal to modla tluc pipelines,
<br /> 490 51,NO REOULATSD PIPING PER HFALTH AND SAFETY CODE,OI V ISION 20,CHAPTER(.7IS CONNECTED 11)THE TANK SYSTEM- Check gds bot ifao
<br /> piping in the limit system is regulabA antler the UST law,or them it or pipinr.
<br /> 49652.V-99 OTHEk-indican,if watlna mdhmt is rased fm Pipeline madtndng.
<br /> 49(7.,51.SPECIFY -Pater n hricf Aescnpdtm of the odor line monhaing mdiimi(xJ nscrl. If ndelilkmnl snacc u ncO1N,.eec Suction X. Ee sure it clemly describe
<br /> matihmng mdhaA(.r)and fnyncnry.
<br /> This monitoring;plan anet include a Site Plan shawinm the general auk and piping layout and Ole locatirms where moakarlog Is militated(i.e.,Incmion ofeoch sensor,line look
<br /> camera,man{tonne syslan control p:mel,em,), If yon already have a diagram(c,g„coaxial US7'Manitming Site Plan from n Mautcring System CatiEcmlat farm.Hatrojim
<br /> M:darinls Business Ilan amr,are.)dint shows all reyaived iaCammion,include it with this Man,
<br /> IJPCP UST-D(1212007)214
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