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<br /> N N) I ;r< iVr�l f ��n�lu.lira}'.(lir 1,[1 111 111.(1 I rInr e� I'il
<br /> l l (nir Ir�irrn.
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<br /> © htONITOItING I-ANH 1 A1,AIt'11 111 (+>It1'
<br /> .--rCtrj 3
<br /> (JSIlr�l Ind 1 ,ICIit LC 1)iilt'lTlCl fr{I �Inrl lld lrlrl�l'I �il!C4IIIdIk',rnrMlr
<br /> rtr,nnit ��Slcnr i� tial cnlr_cnlly r,lloi-vnit ;any �il,��irr.<�r w;r�nini
<br /> hi'dol) rcpo flog, for IIIc pr vwu:; numlh i', ;I�,jjil,11,1, ;111(111;1-. h. , 1 1 by Lht
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<br /> 1rTll�Ilc�l I, 5 l OI>L`.I'iitor. (Allen
<br /> ,11 0 Cnhlr i f tl'71'' alul_!7? 111,S1u!'r r'8�rru f �`�r: 1' tl„ rY,rJ7 � Q'JU _-_J—_ A•
<br /> ~ ddrrlr lire the iI-evious month has hccn res ondcd to a rry rI�Ilr_I i r _-
<br /> © or~,ltx,:sled in tank-to containinctit sumps have not alarmed in the pMst moat
<br /> b.
<br /> is!call tank-rop sun7ps whcre alar nis occurred in the p(rst rttrrnllr O
<br /> 0 - - -
<br /> o/e-Sumps inhere on olorrn has occurred in the{cost r7on117--t he inspected+unless a qualified;Crvive technuror,rerpordt.d r
<br /> G) put perly addressed, the cause of the clan,.Attach documcniotitn7 verlfyyng appropriate serwre to ihts rep/;r/ V/
<br /> `srrrnp urns 1ectton is required,record resutts in iter,G,beta 0
<br /> (C/} _ UST SYSTEM INSPECTION
<br /> 0
<br /> C7 -top containment sumps are free of water,debris,and hazardous substance. Sensors are located prop-fl)
<br /> (p 1e: Ifistro!inspection o sumps is or l} re aired i1v sun7ps where an afarrn has rcrarrred rr,r!'re art n7an/h for xhrch there is no service♦ecr.►d
<br /> Y N r
<br /> W Location: Tank I Pi in .Sunup Location.
<br /> (a
<br /> (D Location.,
<br /> Sur, Location
<br /> M _ ip Location: SumpLocation: _ _ MW�-y�
<br /> O W
<br /> �+ O 1 containment structures are free of water,debris, and hazardous substance.
<br /> Y NA - 0
<br /> N ik 1 —Contents: Diesel Tank 3 —Content's
<br /> 2—Contents: X Tank 4--Contents:
<br /> der-dispenser containment areas are free of water, debris, and hazar dour s ibstance. Sensors are located r+rop,
<br /> Y N NA 1 ` ` O
<br /> N -
<br /> enser 1/2 X Dispenser 9110 0
<br /> O er2rer 3/ X Dispenser 11/0
<br /> Q
<br /> enser
<br /> 516 X Dispenser 13/1� X
<br /> 2) eraser 718 X Dispenser 15/16 X
<br /> PAPERWORK INSPECTION Y N NA DATE DO. O
<br /> -p (D -
<br /> T (i) nFtoring system certification has been completed within past 12 Irlenths.
<br /> ondary containment tests have been completed within the required timeframe,
<br /> ill containment structure(bucket)testing was eom leted within the past year. C
<br /> ttk tightness testing was corn leted within requrled timefialne. C�nti:i
<br /> (D e tightness testing was cornleted within required timefi-ame. Y ,.
<br /> O er required ghnaintenance was completed within required tintefi•ame. (List test/rraartatprtrrrt-e tte' S
<br /> Z
<br /> 00 Test/Afainenance: X
<br /> TesllA9ointenance:
<br /> NTest/A,faintenance: _—�—
<br /> FACILITY rnJPL�YF.E TRAINING
<br /> N .�
<br /> 1 facility em loyees have received the required on the-job is aining within the past year.
<br /> jI facility employ es hired within the past 30 days have received the required on the-joh trainilly l „._ .....
<br /> — ansjwcr of, shoutu Ile explained in the comment section nn the followvmg Rage,and v+ill quire
<br /> C) ow-u Ir action. '.r � - l J
<br /> 4�6 r
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