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7; <br />=V <br />RECEIVE® <br />-T" C11 Get � GtF�U� OCT 13 2017 <br />MONTHLY FACILITY INSPECTION CHECKLIST (Attachment B)� <br />CNVIRONMEN.AL HEALTH <br />PEWITI�ERV� F� <br />Instructions: This inspection record will be completed every month. Place an X in 'ie al 9priate box <br />for each item. If any response requires elaboration, do so in the Descriptions & Comments space <br />provided. Further descriptions 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 leakage ❑ <br />Tanks are damaged, rusted or deteriorated ❑ <br />Bolts, rivets, or seams are damaged ❑ .� <br />Tank supports are deteriorated or buckled ❑ <br />Tank foundations have eroded or settled <br />❑ <br />2 <br />Level gauges or alarms are inoperative <br />❑ <br />ZI <br />Vents are obstructed <br />❑ <br />Valve seals or gaskets are leaking <br />❑ <br />0 <br />Pipelines or supports are damaged or deteriorated <br />❑ <br />Buried pipelines are exposed <br />❑ <br />Loading/unloading area is damaged or deteriorated <br />❑ <br />/_1 <br />Connections are not capped or blank -flanged <br />❑ <br />P <br />Secondary containment is damaged or stained <br />❑ <br />Dike drainage valves are open <br />❑ <br />Fencing, gates, or lighting is non-functional <br />❑ <br />❑ <br />Signature: <br />Date: <br />llacy Truck ano Auto Stop <br />