1

Facility ID Number

13

AN

A facility identifier assigned by the local regulator supporting cross-linking of CERS and local data system records. Because CUPAs do not consistently apply the original regulatory definition of this field (2 AN county 3 AN jurisdiction 6 AN facility number), CERS accepts any alphanumeric string up to 13 characters. The original regulator goals of this field are fulfilled through the CERS ID and CERS System Field “FacilityRegulatorKey” (20.0084).

False

1a

CERS ID

Cal/EPA assigned, 8- or 9- digit ID assigned to a specific facility that never has leading zeroes (begins at 10000001). Cal/EPA does not anticipate using 9- digit CERS IDs until the year 2020 or beyond.

9

N

A CERS ID is a Cal/EPA-assigned, 8- or 9- digit ID to uniquely identify a facility in CERS. The CERS ID should remain unchanged across different owners/operators of a facility.

False

3

Business Name

70

AN

Full legal name of business.

True

103

Business Site Address

70

AN

Street address where facility is located. No post office box numbers are allowed. This information must provide a means to geographically locate the facility. The “Supplemental Location Text” field can also be used to capture additional information where the facility's formal address is unclear or not available.

True

104

City (Business)

60

AN

City or locality name in which the facility/site is physically is located.

True

Equipment Serviced

99 = Other

on monitoring equipment.

490-3b

Specify Other Frequency of Monitoring Equipment Service

Narrative

15

AN

Describes other frequency of service performed on monitoring equipment.

False

2 = Site Plan Previously Submitted

current for the facility.

Monitoring

N = No

04 = Under Vacuum

490-7

Electronic Monitor Panel Manufacturer

25

AN

Name of the tank electronic monitor panel.

False

490-8

Electronic Monitor Panel Model #

35

AN

Model number of electronic monitor panel.

False

490-9

Leak Sensor Manufacturer

20

AN

Name of leak sensor manufacturer.

False

490-10

Leak Sensor Model #

35

AN

Model number of leak sensor

False

N = No

site.

490-12

ATG Panel Manufacturer

25

AN

Name of ATG panel manufacturer

False

490-13

ATG Model #

35

AN

Model of ATG panel

False

490-14

In-Tank Probe Manufacturer

25

AN

Name of ATG in-tank probe manufacturer

False

490-15

In-tank Probe Model #

35

AN

Model number of ATG in-tank probe.

False

99 = Other

490-17

Other Leak Test Frequency

Narrative

10

AN

Other frequency of tank leak test.

False

99 = Other

490-19

Other Programmed Tests

Narrative

15

AN

Other designated sensitivity of programmed leak test.

False

Reconciliation

N = No

N = No

Test Period

02 = 60 Hours

N = No

Frequency

99 = Other

490-25

Specify Other Tank Integrity Testing Frequency

Narrative

15

AN

Frequency of other tank integrity testing.

False

N = No

490-27

Specify Other Monitoring

Narrative

100

AN

Specifies the other type of monitoring.

False

Piping Secondary Containment

N = No

04 = Under Vacuum

490-30

Panel Manufacturer

Narrative

25

AN

Name of panel manufacturer.

False

490-31

Panel Model #

35

AN

Model number of panel.

False

490-32

Leak Sensor Manufacturer

Narrative

25

AN

Name of leak sensor manufacturer.

False

490-33

Leak Sensor Model

35

AN

Model of leak sensor.

False

Automatic Pump Shutdown

N = No

Pump Shutdown

N = No

Performs 3 GPH Leak Test

N = No

490-37

MLLD Manufacturer

Narrative

25

AN

Name of leak detector manufacturer.

False

490-38

MLLD Model

35

AN

Model of leak detector.

False

Performs 3 GPH Leak Test

N = No

490-40

ELLD Manufacturer

Narrative

25

AN

Manufacturer of electronic line leak detector (ELLD).

False

490-41

ELLD Model

35

AN

Model of electronic line leak detector (ELLD).

False

Programmed In-Line Testing

02 = 0.1 GPH

detector (ELLD) test performed.

Shutdown

N = No

Triggers Automatic Shutdown

N = No

disconnection.

N = No

Frequency

03 = Other

490-47

Specify Other Integrity Testing Frequency

10

AN

Other frequency of pipeline integrity testing.

False

N = No

Frequency

03 = Minimum Monthly

Exemption Criteria

N = No

Health and Safety Code, Division 20, Chapter 6.7 Is Connected To The Tank System

N = No

there is no piping connected to the tank system.

N = No

490-53

Specify Other Pipeline Monitoring

Narrative

100

AN

Identifies other monitoring option.

False

99 = Other

490-54b

Specify Other UDC Monitoring

Narrative

15

AN

Indicates type of other under dispenser containment (UDC) monitoring.

False

490-55

UDC Panel Manufacturer

Narrative

25

AN

Manufacturer of under dispenser containment (UDC) panel.

False

490-56

UDC Panel Model #

35

AN

Model # of under dispenser containment (UDC) panel.

False

490-57

UDC Leak Sensor Manufacturer

Narrative

20

AN

Manufacturer of under dispenser containment (UDC) leak sensor.

False

490-58

UDC Leak Sensor Model

35

AN

Model # of under dispenser containment (UDC) leak sensor.

False

UDC Triggers Audible and Visual Alarms

N = No

(UDC).

Automatic Pump Shutdown

N = No

shutdown.

Monitoring System Triggers Automatic Pump Shutdown

N = No

system causes pump shutdown.

of Product at Dispenser

N = No

the dispenser.

Construction

2 = Double-walled

dispenser containment (UDC) construction.

Monitoring

03 = Vacuum

secondary containment monitoring.

Containment of UDC Causes Audible and Visual Alarms

N = No

causes audible and visual alarms.

N = No

Testing

N = No

N = No

N = No

N = No

N = No

N = No

documentation records are kept for the facility.

N = No

facility.

N = No

facility.

N = No

Calibration Records

N = No

Responsibilities are Familiar with Training Documents

N = No

N = No

N = No

N = No

N = No

Owners - Manual and SIR

N = No

Manual and SIR.

Understanding Automatic Tank Gauging Systems

N = No

Automatic Tank Gauging Systems.

N = No

490-69i

Specify Other Training Documents

Narrative

100

AN

List of the other training documents that are used.

False

N = No

490-71

Comments and Additional Information

Narrative

300

AN

Additional information to support the application for an operating permit.

False

490-72

Name of First Person Having Responsibility

80

AN

Name of first person having responsibility for monitoring.

True

490-73

Title of First Person Having Responsibility

50

AN

Title of first person having responsibility for monitoring.

True

490-74

Name of Second Person Having Responsibility

80

AN

Name of second person having responsibility for monitoring.

False

490-75

Title of Second Person Having Responsibility

50

AN

Title of second person having responsibility for monitoring.

False

03 = Authorized Representative of Owner

490-77

Signature Date

YYYY-MM-DD

10

D

Date monitoring plan is certified.

False

490-78

Applicant Name

80

AN

Name of applicant signing monitoring plan.

False

490-79

Applicant Title

50

AN

Title of applicant signing monitoring plan.

False