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MONTHLY ABOVEGROUND STORAGE TANK SYSTEM INSPECTION CHECKLIST <br /> Facility ID# Facility NarnelAddress Qualified Person Signature Date <br /> If any problem Contact <br /> LS found,contact: Hertz Facility Manager Information: d eZ <br /> 'Ni' aw7i '.'„' .�' DESCRIPTION TANK# 5000 <br /> aTEGQ� <br /> _• (Answer questions wdh: Y,N,or NIAi <br /> a ( ,a <br /> s all qu <br /> F�iCR1 C l fRI�?REaYiENTI.Q1�lI.FE ICE <br /> q Spill KitsAre all of the required spill kits in place and properly stocked tat the AST(s) �r <br /> and Fueling Island (s))? ! <br /> Overfill Prevention Is the overfill alarm for the tank working properly? l <br /> 2 Equipment is the tank equipped with a functioning overfill prevention valve? <br /> 3 Anti-Siphon/Solenoid Is the piping equipped with a solenoid or anti-siphon valve? <br /> d Emergency <br /> Stop Has the E Stop been tested to be sure it shuts off the dispensers?CV <br /> ti•. a- <br /> AW <br /> 1 Piping Supports is theabovegroundpiping properly supported? V <br /> 2 Fittings and Joints is there any visual evidence of leaks at fittings, joints or along piping? /l/ fl/ - <br /> r- 1 <br /> t Pressurized Product Line is the underground piping equipped with a line leak detector that is working? If L ` <br /> Leak Detectors (LLD)I electronic, print out monthly tine test result and attach to form. <br /> 2 Slow Flow/No Flow Verify that there has not been a complaint about"slow flow.” If yes, check the � <br /> fuel filters and the line leak detector. <br /> If underground piping has a sump with a sensor,confirm there are no alarms <br /> 3 Monthly Compliance on the Veeder-Root- Print out a"Liquid Status"report and attach test results to t� <br /> this form. ,- <br /> RO.. ll ,5. 0.1103 <br /> Drurnsl Are the drums in good condition? <br /> 2 Secondary Containment Are the drums located on spiil pallets? <br /> 3 Drum Areas Is the drum area clean with no evidence of spills? <br /> 4 Labels Are proper labels on each drum? WA <br /> , <br /> nE ;c fa �raclercts fkr <br /> a <br /> Instructions: Answer each question with a"Y"(Yes), "N" (No)or"N/X' (Not Applicable). If certain equipment is not required and/or not present,make notation in the <br /> column. If a defect is found,describe the problem in the DEFICIENCIES section with a reference to the section and question number and notify the appropriate person <br /> for corrective action. <br /> blJ <br /> 4_ <br /> 7,3 Hwiz Monthly AST Inspedion Form Page 2 of 2 1111?10 <br />