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UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM ( Page s 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 Plan <br /> t- - -- —- - - --- - - - '- - --- - - - - -- - - - - - -- - - - - - - - - - - - - - - - - -- --- - -' " - --- " - - - - - - - -— ---- - -- -- -- -- - ... . . . . _ ' - ' - <br /> Site Address: ; LODI MEMORIAL HOSPITAL 975 FAIRMONT AVENUE LODI CA 95240 <br /> *PIPLN G <br /> (ARROWS) . . . I & . . . . . . <br /> Dratvine of piping <br /> exit of sump and <br /> UDC's. lo Fl F2 �\ <br /> undereround . . . . . . . ( A ) <br /> draivnrp is accurate Fent / <br /> %Ve cannot GIN <br /> speculate blue p X <br /> prints. <br /> TLS <br /> 1 MI) TL <br /> T <br /> . M 0 . . 1 Dar Tank, <br /> _ Fent <br /> HOSPITAL . . . . . . 4 4 4 . . . . . . . . <br /> Qrnole Fill <br /> . OVERFILL w KE <br /> A = :1MNUAR <br /> F = FITS S <br /> Bnro.ul T = TLMBLNE <br /> P = PROBE <br /> . . I . . . . I I I F = VA POR <br /> . . . . . . . . . . . . . X = SIAIPSFNSOR <br /> . - . . . . & L = LeakUetector <br /> BUILDING 4 . . . . 1 6 6 . . . . . . DI = Afzntcav <br /> B = Brine Sensor <br /> I = Smart Sensor <br /> S = STP <br /> . C = Floats Jk Chains <br /> _ . <br /> E = E stop <br /> . <br /> dtit- ftentr are rrof tfcibleto tJx cert(/ifng r ro7arirfmr ra e. a <br /> ji"QfET+'IGIrt10F7InIGr701�,1' QIY�d-E TOlE!'t',fQ' I/�ornntiwrlprng� s. Drm rrr� <br /> /nttoTcde <br /> Date map was drawn 10-28-17 <br /> Instructions <br /> If you already have a diagram that shows all required information, you may include B, rather than this page, with your I'donitaring System Certification. On your site plan, <br /> show the ganaral layout of tanks and piping. Clearly identify locatons of the following equPpmsnt, if installed: monitoring system control panels; sensors monharing tank <br /> annular spaces, sumps , dispenser pans, spill containers, or other secondary containment areas; mechanical at efecuonn line leak detetom; and in-tank liquid level <br /> probes (if used for leak detection). In the aparre provided, note the date this She Plan was prepared. <br /> LEGEND <br />