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0 <br />Automatic line leak detectors will be installed on pressurized piping <br />Manufacturer:______________________ Model: -------------------- <br />--- Annual monitoring will be conducted on the pressurized piping with secondary containment. <br />--__ Annual line tightness test will not be required if the continuous monitor shuts down the pump <br />and activates the alarm system when a release is detected and when the continuous monitoring <br />system fails or is disconnected. <br />OTHER PERTINENT INFORMATION <br />20. ____ State Water Resources Control Board "Facility (A)" and "Tank Permit (B)" application forms submitted. <br />21. —___ Plan review and operating permit fees paid. <br />22. _--_ What is the approximate depth to ground water: __ <br />(include source of information - borehole logs, monitoring__w_ell__data__,___ <br />water____ <br />studies, etc.) : -------------------------------------------------- <br />23. Location of all existing sewer lines, septic tank, pits and lines, and well(s) indicated on plans. <br />24. Total number of tanks on site after installation: <br />25. County/City Fire District and Building Department notified. <br />26. �' _ In the event contamination is observed, confirmed or suspected as a result of a leaking UST system it is your <br />responsibility [in accordance with (CCR) Title 23, Division 3, Chapter 16, Article 11, Corrective Action <br />Requirements] as an owner or operator to submit a workplan to EHD Site Mitigation Unit prior to initiating any <br />assessment or remediation activities. For further assistance contact the Site Mitigation Unit at (209) 469-3450. <br />Na <br />CONDITIONS OF <br />must acknowledge this responsibility for workplan submittal by signature and date below. <br />---------- Title_ L L�G�%/(���'----------- Date <br />0 <br />