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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 /> male Addre=_s. LON MEMORIAL HOSPITAL 975 FAIRMONT AVENUE LOU CA 95244 <br /> . . . . . . . . . . . . . . . . . <br /> Fl Fi <br /> F Fent A <br /> . . . . . . . . . . . . p . . . . . . GL � <br /> _ . . . . T-S <br /> F _ <br /> . . . . . . . . . . . . . . �Ck <br /> . . . .. . . . . . . . . . . . Dav Tanks <br /> . . . . . . . . . . . . . . . . ' . ' . . l�k <br /> . . . . . . . . . . . . . . . ' . . . . . . . . . <br /> HOSPITAL - - - - - ' - - - - - <br /> _ _ - . _ - _ - - _ - cie Fill <br /> . - - 4YERFILL= . . KE <br /> -ai=?LXYIJ AR <br /> F=FELLS <br /> . . . . . . . . . . . . . . T=T Rffi rE <br /> . . . F=FROBE <br /> V_VAPOR <br /> . . . . . . . . . . X-SM EP SENSOR <br /> L=LeakDetemor <br /> BUILDTNG . . . . . . . . . . . . . ai=:ikmTfic <br /> $=$rine Sensor <br /> L}O' I=Smart Sensor <br /> (Almcr _5) S_SfP <br /> D-atV-ing of gipJng C=Floats&chains <br /> Exit Of sttntp and . . . . . . . . . . . . . . . . . . . E=E Srog <br /> LDCs.11-10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> lII1de3PatlDd <br /> drzn,g is _jjJ crena rrrL aao f fltar lata fast risible ro tlta cerr�(tirra fa Taer�rmr tre a <br /> accvrate_ive Fopfa—ark'-d—sdai!r+.farmfa—rd'-pass-a-,rig <br /> cansotspeeuiate rlo-rfosade <br /> blue prints. <br /> :I(- <br /> Date map was drawn SOl28r20 <br /> ns[ructionsl <br /> IF you already have a diagram that shows ail required information.you may include h,rather than this page,with your Monitadng System C-rtdioatian. On your site plan, <br /> show Hoe general layautof tanks and piping. Cteady identity lbraboixs of the Following equomeM if insta&d-mamibmiing system i mtrol panels;sensflrs monitariiM lank <br /> annular spaces,sumps,dispenser pans,spill oamainers,ar other secondary containment areas;mechanical or eteciranic line leak detectors;and in-tank liquid L-M <br /> prohes(if used for Leak de4ecVon). In the space pmvided,notethe date chis Site Pian was prepared. <br /> %Dpitaring System CerlirFreati:Dn Page d oFA <br /> Page 6 of 6 <br />