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Underground Storage Tank <br /> Monitoring System Certification Form <br /> 10. MONITORING SITE PLAN <br /> Date site plan was prepared: <br /> If a site plan has been prepared that shows all required information, you may include it, rather than this page, <br /> with your Monitoring System Certification Form. The site plan must show the general layout of tanks and <br /> identify locations of the monitoring panel, and all leak detection equipment and monitoring locations. Include <br /> a legend for all symbols depicted. <br /> Monitoring System Certification <br /> UST Monitoring Site Plan <br /> Site Address: LODI MEMORIAL HOSPITAL 975 FAIRMONT AVENUE LODI CA 95240 <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> F1 F2 <br /> . . . . . . . . . . . . . O . . . . . . . . . . . . . . . . O <br /> e A <br /> Vent <br /> r GEN X <br /> . TLS <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . 350 TL <br /> x <br /> . T . . . . . . . . . . . . . . . . . <br /> . . . . . . . . . . . . . . . . GEN <br /> . . . . . . . . . . . . . . . Day Tanks <br /> O O <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> . . . . . . . . . . . . . . . . . . . . . . Vent . . <br /> . . . <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . O <br /> HOSPITAL . . . . . . . . . . . . . . . F <br /> . . . . . . . . . . . . . . . . . . . . . . . mote Fill <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> . . . . . . . . . . . . . OVERFILL . . KEY <br /> A=ANNULAR <br /> . . . . . . . . . . . . . F=FILLS <br /> avrosnk . . . . . . . . . . . . . . . . . . . . . . T=TURBINE <br /> . . . . . . . . . . . . . . . . . . . . . . P=PROBE <br /> . . . . . . . . . . . . . . . . . . . . . . V=VAPOR <br /> X=SUMP SENSOR <br /> L=Leak Detector <br /> BUILDING . . . . . . . . . . . . . . . . . . . . . . . . M=Manway <br /> . . . . . . . . . . . . . . . . . . . . . B=Brine Sensor <br /> *PIPING* I=Smart Sensor <br /> (ARROWS) S=STP <br /> Drawing of piping . . . . . . . . . . . . . . . . . . . . . . C=Floats&Chains <br /> exit of sump and E=E Stop <br /> UDC's.No <br /> underground <br /> drawing is IM riamsare reczriisihletoAvice-Yit ingiwAnrdtrF?rea <br /> accurate,we prqf8ssfo—l0prraare-t arxfA'8 sn?,k''f-ipf--r—iprnpus4r. Drrn7'i g <br /> cannot speculate nurroscde <br /> blue prints. <br /> Date map was drawn 10/28/20 <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 Certification. On your site plan, <br /> show the general layout of tanks and piping. Clearly identify locations of the following equipment,if installed:monitoring system control panels;sensors monitoring 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 leak detection). In the space provided,note the date this Site Plan was prepared. <br /> Monitoring System Certification Page 4 of 4 2/21/07 <br /> Page 6 of 6 <br />