Laserfiche WebLink
Monitoring System Certification <br />Site Address: G a ..) b("1'! <br />UST Monitoring Site Plar <br />°f Z l'3 o r /case to i <br />• <br />Ave. M0, o " eca- . i!A 01-5-3-361 <br />. . . . . . . . . . . . . . . . . . . . . . . . . <br />.:. t''.Li� . . . . . . . . . . . . . . . . . . . <br />..' . . <br />. . . . . . . . . . . . . . . . . . . . . . . �?.W• <br />. . . . . . . . . . . . . <br />iv. . . .. .3' .... . . .... ............ . . <br />..................................................... <br />.:..S ::.:::.:.. <br />......................................... ........... <br />. . . . . . . . . . . . . . . . I . . . . . . . . I . . . . . . . . . . ....... <br />_ .1 .... ....... : <br />....................... .ti��: <br />Date map was drawn: l Z' /-Is, /i-3 <br />Instructions <br />If you already have a diagram that shows all required information, you may include it, rather than this page, with your Monitoring System <br />Certification. On your site plan, show the general layout of tanks and piping. Clearly identify locations of the following equipment, if installed: <br />monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary <br />containment areas; mechanical or electronic line leak detectors; and in -tank liquid level probes (if used for leak detection). In the space <br />provided, note the date this Site Plan was prepared. <br />Monitoring System Certification Page 4 of 4 12/07 <br />E <br />R;"F <br />....................... <br />....................... <br />=EB 01 2017. . <br />ENVIRONMENTAL HEALTH <br />. . . . . DFRARTMENT . . <br />h <br />. . . . . . . . . . . . . . . . . . . . . . . . . <br />.:. t''.Li� . . . . . . . . . . . . . . . . . . . <br />..' . . <br />. . . . . . . . . . . . . . . . . . . . . . . �?.W• <br />. . . . . . . . . . . . . <br />iv. . . .. .3' .... . . .... ............ . . <br />..................................................... <br />.:..S ::.:::.:.. <br />......................................... ........... <br />. . . . . . . . . . . . . . . . I . . . . . . . . I . . . . . . . . . . ....... <br />_ .1 .... ....... : <br />....................... .ti��: <br />Date map was drawn: l Z' /-Is, /i-3 <br />Instructions <br />If you already have a diagram that shows all required information, you may include it, rather than this page, with your Monitoring System <br />Certification. On your site plan, show the general layout of tanks and piping. Clearly identify locations of the following equipment, if installed: <br />monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary <br />containment areas; mechanical or electronic line leak detectors; and in -tank liquid level probes (if used for leak detection). In the space <br />provided, note the date this Site Plan was prepared. <br />Monitoring System Certification Page 4 of 4 12/07 <br />E <br />