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Con tete a separate UST Monitoring Plan for each UST Monitoring Plan-page I instructions UST monitoring system at the facility.
<br /> acili
<br /> App cation and within 30 days of changes in the information it contains. Please note that your local agency may require
<br /> mod ing monitorin a ui ment. tY This form must be submitted with your initial UST Operating Permit
<br /> 490- . TYPE OF gCTTONP (Neta: Numbering to these instructiaos follows the data element numbers on fhe frm) You to obtain approval prior to installing or
<br /> 490- PLAN TYPE- Check the appropriate box to indicate why this plan is being submitted.
<br /> Check the appropriate box to indicate whether this plan covers all,or merely some,of the USTs at the facility, If the plan covers oNy some of the tanks,
<br /> identify those mops in the space provided(e.g.,by using the Tank ID#(a)in item 432 Of the UST Operating Permit A Iicatian-
<br /> 1. FACILITY ID NUMBER-This space is for agency use only 3. BUSINESS NAME_Enter the complete Facility Name. PP Tank Information Fonns
<br /> 103. BUSINESS SITE ADDRESS- ())
<br /> ddress
<br /> Entans t locat thefac 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 ENTOrpomted ares in which the facility a located.
<br /> 490.3 MONITORING EQUIPMENT IS SERVICED-Check the appropriate box to specify the frequency ofmonitorin
<br /> 490-36 Specify Other frequency for monitoring equipment servicing.
<br /> on
<br /> 490.4 SITE PLAN- gequipmenl teshnPJcettificeb
<br /> a Bite Plot elm/Map showing the tank and i m la outs and the lex adonS where monimrmg is performed(i.e.,location and is cur probes,hoe leak detectors,monitoring system
<br /> ndirate w a sip plok is submitted with this monitoring plan or Wit was submitted previously and is current for the facility.Monitoring Ofo
<br /> control penal,etc.). Piping 8 Y
<br /> 490.5 V-1 CONTINUOUS ELECTRONIC MONITORING- b plans must mdude
<br /> 490-6 ECONDARY CONTAINMENT_ Indicate if this monitoring method is being used to monitor the tanks
<br /> 490-7 If(V-1 is checked,check the appropriate box to describe the environment inside the tank second
<br /> 490-8 DEL#-I�q���--IfIV-1 is checked,enter the name ofthe manufac[umr ofthe monitoring system canvol panel(c°nsole).
<br /> 490- 1 is checked,entm the model number for the monitoring system control panel. secondary containment.
<br /> 9 EAK SENSOR MANUFA
<br /> 490.11 ODEL# CTURER-Ithe m is checked,enter the name ofthe manufacturer of Ne sensors),If additional space is needed,use Section X.
<br /> 490 11 2 A (S)-_IfIV-1 is checked,enter the modal number for each type of sensor installed.ifaddi6onal space is needed,use Section X.
<br /> AUTOMATIC TANK GAUGING-Indicate ifthis method is used for monitoring ore UST's.
<br /> 48012 ANEL MANUFACTURER-IfIV-2 is checked,enter the name ofthe
<br /> 490'13 ODEL#-IfIV-2 is checked,enter the model number for the monitoring
<br /> Ofihe monitoring
<br /> 490-14 -TANK PROBE MANUFA g system control panel. g system control panel(console).
<br /> 490-15 , #S - CTU1tF,R-If IV-2 is checked,enter the time ofthe manufacturer of the probe(s).
<br /> 490-16. T IfQU is checked,enter the model number for each type of in-tank probe installed.If additional space is needed,use Section X.
<br /> 490.17 S ECl ST FREQUENCY_IfIV-2 is checked,check the appropriate box to describe the in-
<br /> IfEC-16aTES is checked emer the frequency ofpm tank leak test frequency.
<br /> 490-18.1 OGRgMMED TESTS
<br /> chec ed Bemmed lebox tos.
<br /> 490-19.S ECIFY-If 490_ 2 is checked,check the appropriate box o describe the tests m
<br /> 490.20.I 3 RE is checked,enter the frequency Of in-tank leak testing. P granrmed into the ATG system.
<br /> INVENTORYRECONCB,IATION-Check the box ifstabstical inventory reconciliation is performed.
<br /> 490-21.1 4 WEEKLY MANUAL TANK GAUGING.Indicate if this method is used to monitor the tanks.
<br /> 490.22.T STING PERIOD-T I V-4 is checked,check the appropriate box to describe the MIG testing
<br /> 490-23.IV 5 TANK INTEGRITY TESTIN
<br /> 490-24. T FREQUENCY- G:Indicate if this method is used[t monitor the tanks, Period,
<br /> 490.25. :If490-24c is Checked,'spedty other fechecked,check e appropriate box to describe the frequency of lank integrity testing,
<br /> 490-26.IN 99 OTHER;Indicate if monitoring of the tanks occurs that is not indicated in any other category.
<br /> 490'2. V CR§checked,enter a brief description of the other Wile monitoring methods)used(e.g.,vedose zone monitorin
<br /> 8.3 CONTIN). Includ ONITOi[using frequency(e.g.,Continuous,Weekly). Ifadditionals
<br /> 490-28. V- CONTINUOUS MONITORING OF PIPE/PIPING SUMPS g Per 23 CCR§2647,
<br /> Ind: ate i'this is the monitoring method used for the piping ( )AND OTHER SECONDARY Cpm we a Seectio X' �0�d er monitoring per
<br /> 490-29.SE ONDARY CONTAINMENT
<br /> P P g WITH AUDIB LE AND
<br /> 490.30 P AINMENT:If V-1 is checked,Check the VISUAL ALARMS:
<br /> 490.31.MO L MANUFACTURER-If V- enterappropriate box to describe We environment inside piping Secondary
<br /> MANUFACTURER
<br /> is checked,enter the Model or ththe enen°itoring system contrapcoWmtonn
<br /> 490-32.Le of the manufacturer g system control panel(console).
<br /> n�nment.
<br /> SENSOR MANUFACppg _If V-1 is checked,enter the name of the onufacorer of the sensors).
<br /> 490-33.MO EL#(S)_If V-I is checked,enter the model number for each type ofsensor instNled.If additionN space is needed,use Section X.
<br /> 490.34.PIP G LEAK ALARM TRIGGERS A
<br /> 490.35.F IIRE/DISCONNECTTON OF AUTOMATIC PUMP SHUTDOWN-If V-1 is checked,check Yes or No.
<br /> 490.36.V-2 IPE MECHANICAL L THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMPS _
<br /> 490-37.
<br /> Mi
<br /> MANUFACTURE ME LO DETECTORS PERFORM 3 GPH LEAK TESTS:Indicate if this mI SHUTDOWN
<br /> g If method s is
<br /> to monitor the Pipelines
<br /> Sec n X. R(S)-If V-2 is checked,enter the namc(s)of rhe manufacmrer(s)of the mechanical hoe Teak detectors).If additional space a needed,use
<br /> 490-38.MO #(S)-If V-2 is checked,Enter the model number for each
<br /> 490.39.V-3 E ELECTRONIC LINE L tl'Pe of mechanical line leak detector installed.If additional space is needed,use Section X.
<br /> 490-40.ELL MANUFACTUREREAK DETECTORS:Indicate if Pe
<br /> monitoring method is used to monitor Ore pipelines.
<br /> 490-0I.MOD # -IfV-3nchecked,Enter the name of the manufacturer of the electronic line leak dePipeline
<br /> 490-42.PR (S)n- If V-3 MlvfED LINE D checked,enter the model number for each type Of electronic line leak detector installed.If additional Space is needed,use Section X.
<br /> 49043,EL DETECTIONF q PIPING EAK ALARM
<br /> is checked,check the appropriate box to describe the
<br /> 490-44.ELLD DEFECTION OF A PIPING LEAK FAIL TRIGGERS PUMP SHUTDOWN-If V- type of tests programmed into Ore monitoring system.
<br /> 490.45.V-4 P E URE/DISCONNECTION TRIGGERS PUMPI is checked,check Yes Or No.
<br /> INTEGRITYTESTING-Indicate if this monitoring method is used to monitor the pipelinesS �OWN,
<br /> 49046.TEST REQUENCy_If y-4 is checked,check the appropriate box to describe the frequency of P'Pe iota If Vd is checked,check Yes or No.
<br /> 490-48.SPEC Y-If 490-46-99 is checked,enter the frequency of pipe integrity testing.
<br /> 490.48.V-5 VI UAL PIPE MONITORING- P P integrity testing.
<br /> 490-49.IfV-5checked,check the Indicate if this monitoring method is used to monitor the pipelines.
<br /> 490-50.SUCl'I NPIPING �PrX>°I�TION box to describe the frequency of visual moitoring.
<br /> 490-51.NO RE MEETS E CRITERIA- Indicate if this monitoring method is used to monitor the pipelines.
<br /> ULATED PIPING PER HEALTH AND SAFETY CODE,DIVISION 20,CHAPTER 6.715 CONNECTED TO THE
<br /> piping in the tank system is regulated under the UST law,or there is no piping,
<br /> 490.52.V-99 O HER-Indicate if another method is used for pipeline monitoring. TANK SYSTEM- Check this box if no
<br /> 490-53.SPECIE -
<br /> Were brief description of the Other line monitoring methods)used. Ifadditimnal space is needed,see Sectien X. Be sure to clearly describe
<br /> monito Who (S)and Bequenty.
<br /> This moitoring IN must include a Site Plan showing the general tank and Piping detector,monito g system control P p g layouts and the fixations where monitorin is
<br /> Materials BusinPerformed(I, location Of each sensor line leak
<br /> e Plan map etc.)that shows all required informatioYou already n,include it with Oris plan. Moioring Site Plan from a Monitoring System Certification IMM,Hwimdous
<br /> UPCF UST-D(1 007)2/4
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