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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 /> USTWW"ske Platy <br /> ---------------•------ - - - - <br /> SUAddress: LODI MEMORIAL HOSFII AL 915 FAIRMONT AVENUE LOIN CA 95240 <br /> IPL\G} <br /> acing ofppiag - <br /> asitofeurnpard <br /> s.tic <br /> crap:irk i a [ ) Vent A <br /> a,xurate, e �J <br /> camtat speslate ,- <br /> blue Frinn. o v x <br /> TLS <br /> f <br /> F"I <br /> 1 <br /> CQX . <br /> HOSPIT�rLQno*FM_ <br /> : . <br /> s CYER`I�L,., K:1 <br /> A_.-L\\l'L4..Sewet <br /> ;rr F=FILL: <br /> 1'=TAPCR <br /> P=PRCEE <br /> L=Turhtne LinkDetetlar <br /> BL'Z DIIv G 1=SUN 1P�ftiNSCR <br /> B=Brine�amr <br /> S=Stuart�.*uw <br /> C=rbsrs&GlAia: <br /> I=E Snap <br /> atr.irern-llwir;rrnarlydrersreryaitsiNerofix tero rxlritirnrara <br /> p•gkrriarai ayi*asp orX4 and yr sdah;Fw•u�o.�rxnrarvl prupac s.Dreg rrr6 <br /> nar-o:rde <br /> Da)e trap,vas traan iC-2d-17 <br /> In3t—tiona <br /> 14 you already have a jiag-am thatshoius all required irforrration.you xray induce it,rather than this page,whh your Noniioring System Ce&Acatioa. C your ste pan, <br /> :hew Magarnrallayo�t o'rano:aid Aping Cbart/dantiFj bcat;ere et rho follrxvina aquiprrant,iF inaal6d non tonrg:y:tam a tm parole;sanron mornonng tank <br /> annuar spaces,sumps dspenser pats,spill corta:ners,or other secandaryconammen:areas nechannal or ele;retic Ine leak detectors:and in-tant ligaid levet <br /> l:robes Ip used ter�_-aR acectani. to me s:ace prcwo-a.nice me care this 51te Par.was prepamo. <br /> LEGEND <br />