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02/05/2003 08:11 9163712450 BZ MANITANENCE PAGE 12/13 0 0 UST Monitoring Plan—Page 1 Instructions Cump)cft a sepasse,UST Monitoring Plan for each UST monitoriag system at the facility. This forth Must be submitted with your initial UST Operating Permit Application and within 30 days Of changes in the InfbMation it contains. Please note that your local agency may require you to obtain approval prigI to installing or modifying monitoring equipment. (Note: Numbering of the"instructions follows the data element numbers on the fwm') M.01. TYPE,OF ACTION—Cheek the apptopriitt box to indicate why this plan is being submitted. NfU PLAN TYPE—Check the appropriate box to indicate whether this plan emem all,or merely some,of the UST,it the facility. if the plan covers only some.of the tanks,identify those twkR in the apacc provided by using the Tank ID N(s)in item 432 of the UST Operating Permit Applicahm-- Tank Tank Fmm(s)]. FACILITY IT)NUMPIER—This space is for agency use only. M01 17ACEUTY NAMF3—Enter the complete Facility Nam,c, M04. FACILITY SITE ADDRESS—Eimer the street address where the facility is located,including building number,if applicable,Post office box numbers are not acceptable, This iliforization must provide it me=to locate the facility geograjibically, M05. CITY—Enter the city or unincorporated amp in which the facility is!neftel, M06, MONITORING EQUIPMENT IS SERVICED—Checked the appropriate box to specify the frequency of monitoring equipment te5ting/carlification, MOT SPECIFY—If item U-99 is checked,enter the frequency of monitoring equipment tcsting/ccrtifcadan. M10, TANK MONITORINO ME-114OD(S) —Check die appropriate box(cs)in Section IV to identify all required methods used ror monitoring LIST(3) covered by this)than, M!1, SECONDARY CONTAINMENT IS—Check the appmpHate box to describe the envirormin Inside tank Secondary oontainmori. M13, rAODeL 9—if item EV-11 is checked,enter to model number fbr the motiltoring m1cm,control panel, M14, LEAK SENSOR MANUFACTURER—If item TV-1 it checked,enter the name of the manurherwer of the scnsor(s).If additional spa=Ls needed,use Section IX. M15. MODEL#(S)—If item IV-1 is checked,enter the model trumberfor each type of sensor installml,if additional space is needed,use Section IX M16, PANEL MANUFACTURER—If item IV-2 L,%checked,enter the nun of the manufauttm of the monitoring system control panel(console), MT,7. MODEL 0—If item IV-2 is checked,enter Me model number for the monitoring system control panel, M18. IN-TANK PROBE MANUFACTURER--If item TV-2 is checked,enter the name of the manufacturer of the probc(s). M19. MODEL N(S)—if item IV-2 is checked,enter the model number trot each type of in-tank probe installed.If additional space is nec&4 use Section IX M20, LEAK TEST rMUENCY—if item TV-2 is checked,check the appropriate box to dcscribc the in-tank Ical<test frequency, WI, SPECIYY—If item M20-o is checked.,enter the frcqucricy of programmed leak t"tq. M22. PROGRAMMED TESTS—If item IV-2 is cheekod,check the appropriate box to describe the tests programmed into the ATO*stem. M23. SPECIFY—if item bCZ-e is checked,enter the frcqucnoy of in-tank leak testing. M24. INVENTORY RECONCILIATION—If item IV-3 is chocked,check tlic appropilatc,box to demrifir the type of inventory reconciliation performed (ix.,Manuel or Statistiael). M25. TESTING PERIOD—If item IV-4 iv checked,check the appropriate box to deparilic the VITO testing period. M76. TFST FREQUENCY—If item IV-5 is checked,check the appropriate box to describe the frequency of tank intop.riity te.9ting. M27. SPECIFY—If item 1v-5-c,is checked,enter the frequency of tank integrity toting. h28. SPECIFY—If item TV-99 is checked,enter a brief description or the other tank monitoring method(s)used(e.g..vadorc zinc monitoring per 23 CCR §2647,groundwater monitoring per 23 CCR§2648), include the monitoring ficquency(e.g.,ContinuotLi,Weekly). if-additional space is noadeid,use Section IX, M- 30, PIPE MONITORING METI-IOD(S)—Cheek the appropriate box(es)in Section V to identify all required methods used for monitoring piping in the USTsystom(s)covered by this plan. M31. SECONDARY CONTAINMENT is—Check the appropriate box to describe the environment inside piping icconday coatairimarA, M32, PANEL MANUFACTURER—If item V-1 is cheeped,enter the name of the manufodurcr of the monitoring system control panel(console), M13 MODEL 9—If item V-1 Is checked,enter the model number fpr the monitoring system control panel. M34. LEAK SENSOR MANUFACTURER—If item V-1 is checked,enter the nimic,of the TA41010101111tef of the s0fis0f(s). M35. MODEL#(9)—Iritern V-1 is checked,enter the model number far each type of sensor installed.If additional space is needed,use Section IX M36, W11.%PTPrNG LEAK ALARM TRlOGER PUMP SHL7DOWN7—If item V-1 Is checked,check Yes or No. M37. WILL FAILLTzOISCONNECTION OF MMTOMO SYSTEM 1]UOGFR SWtJTW'%W?—If item V-I is checked,chock Yes or No. M38 MjjD MANIJFACTURER(S)—If item V-2 is checked,enter the TIRMC(S)Of thornpifillfhOnIfer(s)of the mechanical line leak dettetoilq).If additional ,space is needed,use Section IX. M39, MODPI,0(s)—If item V-2 is checked,enter the model number for coch type of mechanical line leak detector installed.if additional space is rtecdcd, use Section IX. M40. ELLD MANUFACTLMI-It—If item V-3 is checked,enter the name of the manufsailmor of the electronic'int leak detector(s). M41, MODEL#(8)—If Win V-3 is checked,enter the model number for each type of electronic line leak detector installed.If additional trace is needed,use Section IX M42. PROGRAMMED LINE INTEGRITY TESTS—If Item V-3 is checked,chock the appropriate box to describe the typc of testa prtigraintriod into the monitoring system. M43. W11.1 FLLD DETECTION OF A PIPING LEAK ALAPM TRIGGER PLW SHUTDOWN?—If item V-3 is checked.ciicok'Yes or No. M44. WILL ELLD FAILURE01SCON1,M-CTION TRIGGER pUmpS14UTDOWN?—if Ram V-1 is checked,chock Yes or No, M45. 'TEST FREQUENCY—It item V-4 is cho*0,cheek the appropriate box to describe the frecittency of pipe iniceTity tc4tirl& M46. SpFrlFy—if item V4-c is checked,enter the frequency of pipe integrity testing, M47. VIS'k.TAL MONITORING DONE —If itern V4 is checked,check the appropriate box to describe the fmquoncy of visual monitoring. M48. SPECIFY—If item V-99 is chodAWd,enter a bricf description or die other line m0nithriftg method(s)used, if additional space is needed,use Section IX, Be sure to clearly describe monitoring mothad(s)and frequency, This monitoring plan must include a Site Plan showing the general tank and piping layouts and the locations where monitoring is performed(ix.,location of cnah sensor, line leak detector, mono orin F)a*in control.panel, etc,), if you already have a di sg=(e.g., current UST Monitoring Site 71im frim a Monitoring System Cortiflestion form,Hazardous Materials Boniness Plan map,etc.)which shows all required information,include it with this plan. 07MM ,UCEliU)6d(Q7A0)-2/4