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UPCF UST Monitoring Plan- ]Page 1 Instructions
<br /> Complete a separatc UST Monitoring Plan lin ruins I)s,l'monitoring system, at the ftloility. Thi,: form rnuet be submitted.with your initial UST
<br /> Operating Permit Application and within 30 days of changes in the information it contains. Your local agency may require you to Main approval
<br /> prior to installing or modifying monitoring equipment.. (Note: NunmbcTiny.,of these instructions follows the data element numbers on the form,)
<br /> 41x0-I. 'fYpT'OF ACTION-Check the appropriate oux to Indlcatc why this plan is twirtg.ulrnei bud.
<br /> 41X)-2. PLAN TYPE-(:heck the appropriate box to indicate whether this plan Covets all,or meroly some,of the USTs at the facility. If the plan covers only some of
<br /> the tanks,identify those tanks in the space:provided[e.g.,by using the Tank ID#(s)hl item 432 of the UNT Operating Permit Application-Tank Information
<br /> ports)].
<br /> I. FACILITY ID NUMBER-This space is for ageticy use only.
<br /> 3. BUSINESS NAME-Enter the compict:Facility Name.
<br /> 103. BUSINESS STTF.ADDRESS Enter the street address where the facility is located,including building number,if applicable.Post Office box numbers are not
<br /> amid vable This iniinmation must provide a mtrdns to IN,=die facility geographically
<br /> 104. CITY-Enter the city or unincorporated area in which the facility is located.
<br /> 490-3a. MONITORING EQU fPMENT IS SERVICED-Check the appropriate box to spceity the frequency of monito(ing equipment testing/certification.
<br /> 490.3b. Specify Other frequetky for monitoring equipment servicing.
<br /> 4o0-4, S1TF.PLAN . Indicate if a site plan/ntap is submitted with this monitoring plan or if it fres submitted previously and is current for the facility. Monitoring
<br /> plans must include a Site Plot Plan/Map showing the tans: atul piping layouts and the locations where monitoring is perforined(i,e.,location of scnsot•s.
<br /> probes,line ludo detectors,monitoring system control panel,etc.).
<br /> 490.5. 1V-I CONTINUOUS Iii.F?(7TRONIC MON ITOKINC indicate ifthis monilofin}t method is being used to munitot the tanks.
<br /> 40". SE1-*0NLIA Rr.V(YmNTAiNMFNT' If I V-1 is checkod.check file apnrooriate box to describe the environment inside the tank smondary containment
<br /> 4'W-7. PANEL MANI JFACTU RER if fV•t is checked,enter the name of the munufacturer of the monitoring system control panel.(console).
<br /> 490-8. MODEL 8-If FV-1 is checked,enter the model number fur the monitoring system control panel.
<br /> 440-9. LF,.AK SENSOR MAN LlFA(TURF.R IfIV-1 is checked.enter the name of the manufacturer of the sensor(s).If•additional spacv is needed,use Section X.
<br /> 100 10. MOT)FT.#(S)-tr lv-1 is uheV1,.z 1,rnrrr the nuvittl nnrnbe(for each type of sensor installed.If additlonai space is needed,use Section X.
<br /> 490.11. IV-2 AUTOMATIC TANK GAUGING-lrldicate if this method is used for monitoring the UST's.
<br /> 490.12. PANEL MANI IFACTURER-If Iv-,2 is checked,enter the name of the manufacturer of the muniturine syslern control panel(console).
<br /> 490-13. MOTIF.L.#-If IV-2 is checked,enter the model number for the monitoring system control panel.
<br /> 41014. IN TANK PROBE MAN()rACTIJRF.R-irIV-2 nl'6w.inantifacturerofthe probefs).
<br /> 49U-15. MODEL fi(S)-If fV-2 is chocked,enter the model number for cath type of in-tank probe installed.Ifaddititmal space is needed,use Section X.
<br /> 490,16 LEAK TEST FREQUENCY-I iV-2 is chocked,0=k the;appropriate box to describe the in-lank leak test frequency.
<br /> 490.17, SPECIFY-Tf41X)-I6c is ChCckcd,enter the frequency of programmed leak tests.
<br /> 190 18. PROGRANIMfiD"TESTS-If TV-2 is checked,cltvcL ihr.niiprarriarr Fra to dawirilnl the testa programmed into the ATU system.
<br /> 41X)-19. SPECfI'Y-If 490-1 Be is checklxl,mics the:ficgne:ncy of in-tank leak testing.
<br /> 4%-20. IV-;fNVTiNTOT(Y RF.C'ONCII.IA I ION--Chock the box II'statistical invcnirM reconciliation is performed.
<br /> 490-21. IV-4 WfiFKI.Y MANI JAL TANK GAUG(NCu.Indicate if thts method is used to monitor the tanks.
<br /> 440-22. TESTINCT PF,RIOT) WI V 1 ec ch4w:koh,,+cck the appropriate box io das_rd:k thn MU,io<rinL,rwrirnl
<br /> 490-23. IV-5 TANK IN'rECiRi'1'Y 1ESfiN6 Indicate if this method is used to monitor the tanks.
<br /> 490-24. TFST FREQUENCY ff[V-?is checked,chock the appropfiatc box to describe the frequency of tank intottrity testing.
<br /> 490-25. OTHER:IC490-24c is c)4cked,specify other Lost ftequmcy.
<br /> 490-26. IV-99O111It:K.htda,.dlr if monitoring ofthc funks"cut-that in not indiaattut in any otlw;cntetiory.
<br /> 440-27. if IV-99 is checked,enter a brief description of the other tank monitoring medlixi('s)t>scd(e g.,vadose zone monitoring per 23 CCR}2647,groundwater
<br /> monitoring per 23CCR 42648). Inc(ucte the:monitoring frequency(e.g_Continuous,Weekly). If additional space is needed,use Section X.
<br /> 490-28. V-1 CONTTNUOIJS MONCI"OR(NG OF PIPFJPIPINU JUMPS) AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND VISUAL
<br /> AI,ARM:J.Inui.L.if dei.is tlit monitoring,r nLthcnl uxcd for the piping.
<br /> 490-29. SECONDARY('ON*[AINMCNT:If V.I is checked,Check the appropriate box to des-ribe the environment inside piping secondary containment.
<br /> 490.30. PANEL MANUFACTURER-If V-1 is Checked.cuter the name of the ttlanufelcturcr of the monitoring system control panel(console).
<br /> 440-31. M0 DF:L#-(f V-I is checked,enter the model number for the monitoring system control pallel.
<br /> 490-32. I.FAKSFNSORMANLINA(:'fL)Kt-,K-IfV-1 isCIIC00,enter the name ofthe manufacaiicrvt'flu wuui(q.
<br /> 490-33. M()f)F.l.#(S)•-1 f V-1 is Checked,enter the model number f'or each type of sensor installed.If additional space is needed,use Section X.
<br /> 490.34, PiPiNG LEAK ALARM T PlG(iF.RS AUTOMATIC 11IIMP SIA JTT)OWN -If V-I is checked.check Ycs or No.
<br /> 49035. FAII.IJRE/DISCONNLCTION OF THE MONI'f(1K1NG SYSTEM 'TRIGGERS AUTOMATIC PUMP SHUTDOWN-if V-1 is checked,check Yes or No.
<br /> 49036, V-2 PIPE;MECHANICAL]:INF LEAK I El*i(_CORN PERFORM 3(il•H LEAK t LS 15:Indlcatc irmts monitoring method is used to luvi iun die Fif Biles.
<br /> 490-37. MI,I,D MANUPAC"TURER(S)-If V-2 is chcckcd,tinter the names)of the manufucturer(s)of the mechanical line leak detector(s). If additional space is
<br /> needed,(use Section X.
<br /> 490.38. MODF.I,#(s)-If V-2 is checked,Enter the model numW(for trach type of mechanical line leak detector installed.If additional space is needed,use Section
<br /> X.
<br /> 41X-39. V-3 PIP] ELECTRONICI.INE Lf:AK DLf1iCl'OItS Indicate if this monitoring Tocthod is used to monitor the pipe[inus.
<br /> 490-40. E.LLD MAN Ur,ACTURF.R-if V-3 is ctiecked.Filter the name of the manufacturer of the electronic line Irak detector($).
<br /> 49041. MODLL II(S) if V-3 is checked,enter the model number for each type oTelectronic.line leak detector installed.if additional space is needed,use Section X.
<br /> 4'x)-42. t'Re')C.RAi1.1MI?r)i.TN1'1NTr-.GRI'rV Tr-.STS .Tf V-3 is checked,chcuk the apgi'opritttr,,box to&scrihc the type,of tests programmed into the Monitoring
<br /> system.
<br /> 490-43. ELLD DUI'UC'I ION OF A PIPING LEAK ALAKM'rPIC,(.,FRS PUMP SHUTDOWN If V.I is chucked,check Yes or No.
<br /> 490-44. ELLU DETEC71ON OF A PIPING LEAK VAILURFJDISC.ONNECTION TRIGGERS PI.JMP SHUTDOWN-If V-I is checked,cheek Yes arNo.
<br /> 4110-45• v-4 f(P8 INTF0RITY TESTING Indicate if this monitoring method is used to mt)nitor the pipelines.
<br /> 440-46. TEST FREQI JF..NCY-If V-4 is checked,check tlic appropriate box to describe the frequency of pipe integrity testing.
<br /> 490-47 SPECIFY-If 411(1-46-99 is checked•enter the frequency of pipe inteF.,fity testing.
<br /> 490-48. V-5 VISUAL PIP(;MONffORING-Indicate tl'this tnttrritoring method is used to monitor the pipelines.
<br /> 490-49. If V-5 is checked,cheek the appropriate box to describe the frequency of visual monituring.
<br /> 490-50. SUCTION PiPINCI MEETS F XIiMP 1'[t)N C'121TFR1A- Indicate if this monitoring method is used to monitor the pipelines.
<br /> 4917.51. NO RFflF1JI.A'rF:D PIPING PL''K IIEAUTI l AND SAFETY CODE,DIVISION 20,CHAPTER 6.7 IS CONNEC71'LV T0'I'l1F TANK SYSTEM- 0XI-Ck
<br /> this box if item piping in the tank system is regulated under the UST law,or there is no piping.
<br /> 490.52 V-99 OTHER-Indicate ifanothcr method is used for pipelina monitoring.
<br /> 440-53. SPECIFY -Enter it bticT description of the.other line monitoring racthod(s)used. If additional space is,,puled,sec Section X. Be sure to clearly describe
<br /> monitoring methods)and freclucncv.
<br /> This monitoring plan most include a Site Plan showing the Forlerat tank and piping layouts and the locations where monitoring is performed(i.e.,location of each
<br /> sensor,line li,ak dctcctor,monitoring systum control panel,etc.). if you already have a diagrim(c e_current UST Monitoring Site Pian front a Monitoring System
<br /> Certification tbrm,Hazardous Materials Susincgs Plan map,etc.)that shows all required information,include it with this plan.
<br /> UPCF US•1•-D(1V2007)-2J4 www-uaidocs.org
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