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UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM (Page 6 of 6) <br /> XVI . MONITORING SITE PLAN <br /> Date site map was prepared : <br /> If you already have a site plan that shows all required information, you may include it, rather than this page, with your Monitoring System <br /> Certification Form. The site plan must show the general layout of tanks and piping and clearly identify locations of the following equipment, <br /> if installed: 1) monitoring system control panels; 2) in-tank liquid level probes (if used for leak detection); 3) devices monitoring tank <br /> annular spaces or vault; 4) devices monitoring product piping; 5) devices monitoring fill piping; 6) devices monitoring vent piping; 7) devices <br /> monitoring vapor recovery piping; 8) devices monitoring vent/transition sumps; 9) devices monitoring under-,dispenser containment, 10) <br /> line leak detectors; and 11) devices monitoring any other secondary containment areas. <br /> U ST Monitoring Site PlanK t <br /> -- - - -- - - -- -- - -- - - -- -- - - - - - - -- -- - - --- - - - ' - - - - - -- - -- - - - ' --- - ----- <br /> , _ _ _ SheAddress:_ _16437WBannerRd — Lodi CA SPR 0 `� 2019 <br /> cu000 <br /> - Vents o . <br /> . . . . . . . . . . . . . . . . . . . <br /> ENVIRONMEN 'Al_ HEALTH <br /> .DEPAR FN <br /> . . . . . : . _ . . <br /> oAo(:V : . : _ . : _ . . . . . . . <br /> : : . : . . . . . . . 87 X <br /> F V P ❑T F V P T <br /> X X <br /> DIESEL 91 <br /> I Y - I . - I - R . <br /> 10 <br /> Llon <br /> A= :LTTYULAR *PIPLiG } <br /> F = FILLS 4j <br /> 4 . . _ , . _ - I (BAR0137S) <br /> T = TURBLNE Ihawine of pipiue <br /> P = PROBE 13 ' a u exit of sump and <br /> V = SrAPOR UDC' s. No <br /> l = SU1iP SENSOR underground <br /> L = Leak Detector drat *aux is awiw4 ,. <br /> AI = hisinvv-av 114E cannot <br /> B = Brine Sensor speculate blue <br /> I = Smart Sensor prints. 1 <br /> S = STP 15 . . .T . . J <br /> C = Floats & Chaim V v <br /> E = E Stop <br /> mi <br /> iris items darsround tlat are not visible yo the reri j6irg ieebacimt ora a <br /> f7rgf6SSiorlal cipbdon ontl. mid are folt;&for h1formarionalpurposes. Drmririff <br /> dor to scold <br /> Date map was drawn: 03128119 <br /> Instructions <br /> If you already have a diagram that shows ail required information. you md/ include it, rather than this page, with your Monitoring System CertiScation. On your site plan , <br /> shove the general layout of tanks and piping. Clearly identify locations of the following equipment, if installed: monitoring system cental panels; sensors monilorng tank <br /> annular spaces, sumps , dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak detectors; and in-tank liquid level <br /> probes (if used for teak detectkin). In the space provided, note the date this Site Plan was prepared. <br /> LEGEND <br /> II� <br />