|
2098253593 ENGINEERING DE 0 44 p.m. 09-10-2010 316
<br /> UP UST Monitoring Plan---Page 1 Instructions
<br /> Complete u separate UST Monitoring Plan for each UST monitoring system at the facility. This form must be submitted with your initial UST
<br /> Operating Pen-nit Application and within.10 days of chanAps in the information it contains, Your local agency may require you to obtain Approval
<br /> prior to installing or modifying monitoring equipirictit, (N,r:, Numbering of those 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 sone,of the USTs at the facility, If(lie pian coven;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 US"r 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 S ITE ADDRESS-Enter the streei address where clic facility is located,including building number,if applicable,Post office box numbers arc 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 /> 490-34L MONITORING EQUIPMENT IS S ERV ICED-Check the appropriate box to specity 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 planhilap 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, 1V-1 CONTINUOUS ELECTRONIC MONITORING-Indicate if this monitoring method is being used to monitor the tanks.
<br /> 490.6. SECONDARY CONTAINMENT sr if IV-1 is checked,check etre appropriate box to describe the environment inside the tank secondary containment,
<br /> 490-7. PANEL MANUFACTURER-if -1 is checked,enter the name{of the manufacturer of the monitoring system control panel(console). _
<br /> 490-8. MODEL#-If IV-t is checked,enter tic mode{number for the monitoring system control panel-
<br /> 490.9. LEAK SENSOR MANUFACTURER-if N-1 is chcckcd,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-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 it this method is used for monitoring the UST's,
<br /> 490-12. PANEL MANUFACTURER-If iV-2 iv checked,enter the name of the manufacturer of the monitoring system control panel(console).
<br /> 490.13. MODELk-If IV-2 is checked,enter the model number for the monitoring systcm 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, LEAKrTEST FREQUENCY--If IV-2 is checked,check the appropriate box to describe die in-tank leak test frequency-
<br /> 490.17. SPECIFY-If 490.16e-is'olieaked,enter the frequency of programmed leak tests,
<br /> 490-18, PROGRAMMED TI$STS-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, IVA WEEKLY MANUAL TANK GAUGING.Indicate if this method is used to monitorthc tanks,
<br /> 490-22. TESTING PERIOD-if IV-4 is checked,check the appropriate box to describe the MTG testing period,
<br /> 490.23. 1V-5 TANK INTEGRITY TESTING:indicate if this method'is used to nmonitor die tanks.
<br /> 490-24, TEST FREQUENCY-if IV-5 is checked,checkthe appropriate box to describe the frequency of tank integrity testing.
<br /> 490-25. OTHER:If 490-24c is checked,specify othcrzcst frequency.
<br /> 490.26. IV-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 mothod(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 K .
<br /> 490-28. V-1 CONTINUOUS MONITORING OF PIPE/PIPING SUMP(S) AND OTHER SECONDARY CONTAMMENT 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 covironmcnt inside piping secondary containment.
<br /> 490.30. PANEL MANUFACTURER-If V71 is checked,enter the name of the manufacturer of the monitoring systcm control panel(console),
<br /> 490-31, MODEL#-If V-1 is checked,enter the model number for the monitoring systcm control panel.
<br /> 490-32. LEAK SENSOR MANUFACTURER-If V-1 is checked,enter the name of the manufacturer of the scnsor(s).
<br /> 490.33, MODEL#(S)-if V-I is checked,enter the model number for each type of sensor installed-iF additional,pact 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-IfV-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 namc(s)of the manufacturer(s)of the mechanical line leak detector(s),if additional space is
<br /> riceded,use Section X, i
<br /> 490-38. MODEL 4(s)-if V-2 4s checked,Eater 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 MANUFACTVP ER-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 thamodcl number for each type of electronic line leuk detector installed If additional space is needed,use Section X.
<br /> 490-42. PROGRAMMED LINE INTEGRITY TESTS-if V-3 is chocked,check the appropriate box to describe the type of tests programmed into the monttoring
<br /> system.
<br /> 490.43. ELLD DETECTIOri OF A PIPING LEAK ALARM TRIGGERS PUMP SHUTDOWN-if V-1 is checked,check Yes or No.
<br /> 49044, ELLD DETECTION OF A PIPING LEAK FAILUMDISCONNECTION TRIGGERS PUMP SHUTDOWN-If V-t is checked,check Yes or No.
<br /> 490-45. V.4 PIPE INTEGRITY TESTING-Indicate if this monitoring method is used to monitorthe pipelines.
<br /> 490146. TEST FREQUENCY-If V-4 is checked,check the appropriate box to describe the frequency of pipe integrity,testing.
<br /> 490-47. SPECIFY-If 490146-99 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 fur pipeline monitoring,
<br /> 490-53. SPECIFY-Enter a brief description of the other line monitoring nu:thod(s)used. If additional space is nced6d,see Section X. Be sure to clearly describe
<br /> nioniA'ig t,nethod(s)and frequency.
<br /> This monitoring plan must,include a Site Plan showing the general tank and piping layouts and the locutions where monitoring is performed(i.e.,location of each
<br /> sensor,line teak detector,monitoring system control panel,etcA 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.)(hat shows all required information,include it with this plan.
<br /> UPCF UST-1)(1=007).215 www.uiiidoes.org
<br />
|