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Signature: ,/ g Date: <br />5rc-it <br />Tracy "Druck and AUM Stop <br />RECEIVED <br />-16C)' l!"[4 <br />MONTHLY FACILITY INSPECTION CHECKLIST (Attachment B) <br />ENVIRO�NMENTAL HEALTH. <br />Instructions: This inspection record will be completed every month. Place anp �R"ftiT§ggv�ppriate box <br />for each item. If any response requires elaboration, do so in the Descriptions & Comments space <br />provided. Further descriptions or comments should <br />be attached on a separate sheet of paper if <br />necessary. <br />Yes <br />No Descriptions & Comments <br />Tank surfaces show signs of leakage <br />❑ <br />Tanks are damaged, rusted or deteriorated <br />❑ <br />�1 <br />Bolts, rivets, or seams are damaged <br />❑ <br />Tank supports are deteriorated or buckled <br />❑ <br />h <br />Tank foundations have eroded or settled <br />❑ <br />Level gauges or alarms are inoperative <br />❑ <br />Vents are obstructed <br />❑ <br />Valve seals or gaskets are leaking <br />❑ <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 />Connections are not capped or blank -flanged <br />❑ <br />Secondary containment is damaged or stained <br />❑ <br />Dike drainage valves are open <br />❑ <br />0 <br />Fencing, gates, or lighting is non-functional <br />❑ <br />❑ /✓ <br />Signature: ,/ g Date: <br />5rc-it <br />Tracy "Druck and AUM Stop <br />