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E IJ ED <br />7-<5 p JITH 5;;r OU 1 '; 2017 <br />MONTHLY FACT ITY INSPE TION CHECKLIST (Attachment B)EN1�1RONMENTALHEALTH <br />PFRIV! Tr` FRVfFS <br />Instructions: This nspection rec rd will be completed every month. Place an X in the appropriate box <br />for each item. If aiiy response requires elaboration, do so in the Descriptions & Comments space <br />provided. Further Jescniptions or comments should be attached on a separate sheet of paper if <br />necessary. <br />Yes No Descriptions & Comments <br />Tank surfaces show signs of lea age ❑ <br />Tanks are damage , rusted or del eriorated ❑ <br />Bolts, rivets, or seems are damaged ❑ <br />Tank supports are deteriorated or buckled ❑ <br />Tank foundations Have eroded oi settled ❑ <br />Level gauges or al r ns are inop rative ❑ <br />Vents are obstructc d ❑' <br />Valve seals or gasb ets are leaking ❑ <br />Pipelines or suppo is are damag d or deteriorated ❑ <br />Buried pipelines am exposed ❑ <br />`i <br />Loading/unloading area is damaged or deteriorated ❑ <br />Connections are nc t capped orb ank-flanged ❑ <br />Secondary containinent is dama ed or stained ❑ <br />Dike drainage valvas are open ❑ <br />r <br />i <br />aJ, Fencing, gates, or lighting is non-functional ❑ ❑ <br />jo �S <br />Signature: % Date: / S <br />w <br />I'racy Druck and ALAO Stop <br />