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0 <br /> 11157Mr1 Me i�•t <br /> � <br /> lme `� rI1t1 S n — �T!= ---1 - T:ekl„il ti+si[clr 11:1dr � ' ,-r•.—�..._ V <br /> Cn <br /> ddres's 3 1? C 1� <br /> O cktan 7rli t c?ale: 1J5%r)4 �' <br /> CD tJ 1JST (�peralor C tmdurlin llkc Inspectum: Darren 1(icck �--F <br /> r-r <br /> O ode Council Cert kation Il: 531 ! 00(r DJC, l Npirataurn Inst f)",;r 1 I <br /> -enc © I hrnrc, (3 If j)69X.,)4 Fe - - <br /> C) __.T y+'s•ti ti,. �.t_ti.,t 'ctpF.F.�}i. T1 <br /> c p MONITORING PANE,LIALAItM ITIS-F-Of(V t' %A ! <br /> nitorin , s stem is ow_ered on and in ro er o eratirg mode. — e --- <br /> CD nitorincg Svslem is not currently shotivi�tsimalarms or warnings, r <br /> W rm history rcportilog CL for the previous month is available,and has been reviewed by the <br /> ionated UST Operator AMuch o co.i�n the alui-m history re pori/lo,io this t�rrn r avuiluhle <br /> U o h alarm for the previous month has been responded to appropriately. �i [�. <br /> sors located in tank-to containment sumps have not alarmed in the past month. <br /> r+ List all tank-la rrr .s inhere alarni occ• r i ?seet nth: �--t- <br /> Wore Sumps where an aloin?has occurred in the past inonth must be inspected u?p(ess a qualrfred service technician resp?nded to and <br /> properly addressed,, the enrrse of the alarm? Attach docrinrenrat?on verif wig appropriate service to this report <br /> C/) <br /> f sum inspection is required, record results in Nein C, below. <br /> M UST SYSTEM INSPECTION <br /> w k-top containment sumps are free of water,debris, and hazardous substance. Sensors are located properly. <br /> COL 'te: Visual inspection o sum s is only re aired in suer s where an alarm has occurred sr the ast month or which there is no service record <br /> V <br /> Sv Y Y N <br /> .« <br /> 0SD_ Location: Tank 1 Piping Sum Location: Tr <br /> 0 :3tJ <br /> a:) :3 Location: Sum Location: <br /> CD o Location: 11"IP Location: <br /> C) CD I containment structures are free of water,debris, and hazardous substance. W <br /> © Y - NA Y N NA CO <br /> -Alv I -Contents: Diesel Tank 3-Contents: X O <br /> C-) h 2-Contents: X Tank 4-Contents: x <br /> CDer-dis enser containment areas are free of water_,debris,and hazardous substance. Sensors are located ro er1 . <br /> © Y N NA Y N I NA <br /> C enser 1/2 X Dispenser 9/10 X O <br /> enser 3/4 X Dispenser 11/12 X 0 <br /> enser S/6 X Dispenser 13/14 X <br /> CD enser 7/S X Dispenser 15 16 X <br /> v <br /> PAPERWORK INSPECTION Y N NA DATE DONE Q <br /> Jnitorin s stern certification has been completed within east 12 months. 4L 11-0 0 <br /> o � ndary containment tests have been completed within the required timeframe. N D <br /> o Q 1 containment structure(bucket)testingwas completed within the past year. <br /> k tightness testing was completed within required timeframe. Continuous <br /> j tightness testing was com feted within required timeframe. X <br /> M � er required testing/maintenance was completed leted within re uired timeframe. (List test/maintenance items below.) <br /> oX U) <br /> � e+ Tc s[/.d4aArlenance: <br /> t TesllMc intenance: X .--r <br /> Z m O <br /> 0 (f) Test'Maintenance: (') <br /> _0 FACILITY L'MPLOYEE TRAINING Y N NA eft <br /> M <br /> — acilit),em loyees have received the required on-the-job training within the past ear. 0 <br /> y facility employees hired within the past 30 days have received the required on-the 'ob training. � <br /> on��ver of,'N- should be explained in the comment section on the following page,and sill require <br /> C) -up aetiun. <br />