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06/20/2005 20:35 2095997115 JIMCO TRUCK PLAZA PAGE 06 . "- —•.• terse uo LIST menitorlag Plan—Mage 2 Instruetio" Complete a separate UST MonhmIng Plan fax each VST m caro ;%yst=atalto facility. Acis farm moat be subimutd..ith your initial LST OPwuung Pamt AEplios,5on%ad wahlu 30 dvgs of ohmVes in the mtee c mn it cot»aim. riease nota ttta yws losat ammey may require you m obtail approval Rdff to Wnaftg or taodifying mooile pft equ.;,nc sL (Note Ate ethCrog of dose inatrucdom i0 k,,the data e3eroent numbers on the form.) Mia DieppalSER MONITORING MEMOro)-Check tic approptiatc hwc(oa)in Scania IV a identify all required metbods used%r manituriag the Meas)beneatb the diap6aser(4 Ifni dispewa%am imtatkd(e.g.,UST3 supplying standby geucmta ),cheek item VI-5. 171.PANEL MANUFACTURER-Vise.VI-I is cbeeked,mw the name of the tmtlmtfaeulter of the m boring system==oi panel(emmM). If then Is ao cnaavi pmel(a f-only sn clect.ical play box is inaUN4)kora dais,Va e Manic M52.MODEL 9-If Tram VI-I is checked,enter the model tmmber for themonirot6;system control panel.If there i5 no antral patio(e p_rely at c1coW d relay bac Is hmssmkk3)kerb tris space Nor*- M53.LEAK SENSOR MAN1LTACTUMA,-If item Vl-t is cbedccd,enter the name of the manu£amvcr of the swot(s). M34.MODEL#(S)-If Ilam VI-I is ducked,arks the model mtmber&a web type of Stow installed.Ifadditiooal space is needed,usa$cedes IX. M55.WILL DEIECIION OF A LEAK INTO UDC TRIGGER AUDIBLE AND VISUAL ALARMS?-Ifa'em VI-I is checked,check Yes or No, M56-WILL,A UDC LEAK ALARM TRIGGER PUMPSHUTDOWN?-If item VI-1 is dw*od.ehcdc Yes or No. M57. WILL FAILURFlDISCONNECIION OF UDC MOMT09ING TRIGGER SHUTDOWN?-If item VI-I is ebeebed,cLeckYB orNv h158. ASSEMBLY MANUFACTURER-.Ifiatm VI,21s checked,eater dee name of the mwAkkare oftbe mcchariwF leak dereerioo assapb(y- M59. MODEL S(S)-If itmn VI-2,is-harked,anus the mortal somber For cash type of mwcbsnical leak detection os bly icmaliod,If ajd*tiomet space is neadad,etre Section IX. MN.VISUAL.MONITOMM DONE -If isms VI3 is dxcknd,cheoktlx apl¢updm box to dcacrit a the ttegoency ofvivtal moal"Ing. M61- SPECIFY-If item VI-99 s chocl ed,antes'a br1of'descriptim of the other muthod(s)used to memitor the UUC_ If edditimat space is needed, use Soctkm RL M76.ENHANCED LE6.K DETECTION -Chock/bo bro if you bare been notified by the$lane WAW Resowou Cmvo[Ito"(S'W")that the UST(s)oovwW by this plan Ware subject to E;6xKed Leak Dv*Wan Requwmw.s(i e_,IJST has any single-wall cumpowd and IB lorded within LM6 feet of a public dr(okug..=T VXA). M80.REFERENCE DOCUMENTS NIAINTA24M AT FACILITY-Check the aippropriatc boos to describe mfft" a 4ocnments msinruced at thu f i ity..Nobe that items 11 2r and 3 It=be kept at the facility. - M81. SPECIFY-If item VIII-99 is chocked,tmtc a.brief desatRion of Ike odkx doeument(s)m:tintained at the facility_If additioarl space Is me"use Seedon Dc. M85. COmItiEiNTSIADDTRONAL INFORMATION - You may use this section to describe emy additional UST vstem mamiWring-related idlpmariol(e.9"awatio"to malioa required by your local agency). if using Seceiwt iX as adduimwi space for i(nua rewetieed dscwh= io We p>aa,a-f6r ace the item wrubcr(mg,"freer:M$4-MaW 2469 and 3599 Loak Semsoec'T. OWNER/OPERATOR SIGNATLME The owttrulgmvem shall mgn ra Ow spas paw idui This signature certifies that the signer believes ttmt all intbtmn6on stYbui ud It Clue,wcuraw_att1.complete,and that the training program specified in Seotieo VIII'has lean itrtplettuttted. M90. RMgaSENIING-Check the appmpeusW box W imdicats whether the 3499 is r4w"w as tJk UST weer MUST operator. M91. DATE--finer the date the ptan tree algma t M92.O WNEWOPERATOR NAME.-Prmt or type the wane of the person signing The p1m M93-OWNER/OPF.RATOR TITLE-Eater ft title of IM partes tigran8 Me,Pilo, "-`A 11 v�o Y, r-. SJCEItn-d(07.130-414 07123W