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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 /> annularspaces 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 /> UST Naitmig Sftr Plan <br /> r---.-_-_--------------_-____--._-______-__________-____ <br /> _ _ ------------– _ _ <br /> Site Address: LODI MENURIAL HOSPITAL 975 FAIFMONT AVENUE LOUT CA 96240 <br /> G* <br /> ticimofpipiag . _ . . . . . . <br /> a,dt of IIlifl�and . . . . . . . . . <br /> [SDC'f.tic . <br /> — <br /> fSa,Um is <br /> cams spec:late E <br /> My prints. n x <br /> r_s <br /> T In_ tc <br /> A a <br /> .zt <br /> nea <br /> Fill <br /> KF y <br /> bows F=FILL: <br /> 1'=VARX <br /> P=PRC <br /> L=Turhme LmhDetedrr <br /> BUILDING =til EpI N3CR <br /> B=BtineSawr <br /> 5=Steam S*wci- <br /> Ont item rrm�rnaotirVrtacvsnavliaibletorfucm-[ningrrla'dtmMa <br /> F'C�rC�.tirLT1 OX'1'II01'Otl�:Rrt�NY SQl�.,r.,r 1l�O.-1rCiltaTL'i�vAxs.L?i aid ietg <br /> rnt;O ds <br /> Date rrap was crave X-24-17 <br /> Inrtructium <br /> f you already have a diagram thatshoNs al required information ycu rray incluse it rather tan this;age.w&ycur Noni:oring System Certnccation. Cn your ste Flan, <br /> ;h.,t.c yanara-layoat or tarn.:aid pFing Claart/idonrift lomtiar:c ofthafollavine ogaipnant,i1 in:tallad-nonta. g oyetom centre-parols;csmors monitoring tank <br /> annuar spaces.sumps,dispenser para,spill containers.crother seconlarycomainmen:areas.mechar.i:al or electro-c Ine leak detectors;and in-tent liquid level <br /> probes(p used for*aK delecwn).In ine space procto.note the pace this 5ae Plan was prepareo. <br /> LEGEND <br />