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Fencing, gates, or ghting is no functional ❑ Jh <br />V <br />G c <br />Signature: <br />Date: s -Z <br />'Il acy TRIck and Auto Stop <br />RECEIVED <br />C -O\ <br />OCT e ' 2017 <br />MONTHLY FACILITY <br />INSPECTION <br />CHECKLIST (Attachment B) ENVIRONMENTAL HEALTH <br />Instructions: This <br />nspection rec <br />PERF/71SERVC <br />rd will be completed every month. Place an X in the appropriate box <br />for each item. If aiiy <br />response requires <br />elaboration, do <br />so in the Descriptions & Comments space <br />provided. Further <br />iescriptions or <br />comments should be attached on a separate sheet of paper if <br />necessary. <br />Yes <br />No Descriptions & Comments <br />Tank surfaces show <br />signs of lea <br />age <br />❑ <br />Pf <br />Tanks are damage <br />, rusted or del <br />eriorated <br />❑ <br />JZI <br />Bolts, rivets, or seams <br />are damaged <br />❑ <br />Tank supports are <br />deteriorated or <br />buckled <br />❑ <br />Tank foundations I <br />ave eroded oi <br />settled <br />❑ <br />Level gauges or al <br />nns are inop <br />rative <br />❑ <br />Vents are obstructc <br />d <br />❑ <br />Valve seals or gaskets <br />are leakin <br />❑ <br />Pipelines or suppo. <br />is are damagt <br />d or deteriorated <br />❑ <br />Buried pipelines are <br />exposed <br />❑ <br />Loading/un loading <br />area is damaged <br />or deteriorated <br />❑ <br />Connections are nc <br />t capped orb <br />ank-flanged <br />❑ <br />Secondary containinent <br />is damaiied <br />or stained <br />❑ <br />Dike drainage val <br />s are open <br />❑ <br />Fencing, gates, or ghting is no functional ❑ Jh <br />V <br />G c <br />Signature: <br />Date: s -Z <br />'Il acy TRIck and Auto Stop <br />