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0 0 <br />Designated Underground Storage: Tank (UST) Operator <br />Monthlv Visual Insneeiion Checklist <br />Fatal' Name: <br />' lvi4NTFOW NG PANEL 1 AT.AiaM JMTORY _. <br />Far:ility Address: <br />City: <br />�'�Q•�' <br />I'b. <br />Y� <br />Desigmtcxl UST Operator <br />Co the tion_ Julia" <br />Monitoring oystem is not GYnTft showing a lv alarms or warning <br />International Code Council CW fixation # 8000863 - UC <br />1?. -atim Dago: November 24, 2011 <br />Signature_ <br />Pb me: ( 916 2171373 <br />rr ..., Y=7ea,n=N06NA— Not AbbEwable <br />item <br />' lvi4NTFOW NG PANEL 1 AT.AiaM JMTORY _. <br />Y N INA <br />1 <br />MomtOr�m stem LS e[rd 4A 3tnd W Mo&. <br />2 <br />Monitoring oystem is not GYnTft showing a lv alarms or warning <br />3 <br />Alarm bi," report/log for the pfevions moult is available, and has been rmzwed by the <br />DcsiPattd UST Operator. (A11aeh a spy of the a'--- htslrny - aroog to this fo,m t availa&le-) <br />- <br />4 <br />Fads alarm for the Wrvious has been to <br />5 <br />Visors located ip tanlc to con in f sumps trove t alantted in the mon& <br />5a <br />List all tarp -49p .sumps where alcr►,qu occurred kv dw pact month-- Z <br />.4 r `mac , .. r.T ,Prr :ti qD <br />pa where an aZa m has occurred in the past m&*h tnfW be tnspented >tnteasr a 9v-W9d ser-ce ya)h, kwn responded M. an�x7'� <br />Frope4ly ad4`etst%j the cause Of the alarm Aam* doa maowxM vff�&ng app rewnate J& -wet fo Yhis reyprt. <br />l sump �Yl tiaK td TB(jNfTF� r�cvrd rdfiLiE't, tK tiB�n � below, <br />UST SYSTEM INSPECT1DlN <br />6 Tank -top Containment gwnps are froe of water, debris, and kmwdous subst . Scwors are located pt+aperly- <br />1Tote: Visual ins CA'an sum s is only red in a where QK alarm has oc"fred in the past moWh fpr which titers is mo servlc2 record <br />Y N �s"� Y N <br />Sump Location_ 91 r: Sum Loco " <br />"l+ rrryrt: 87 N . <br />,Cum Location_ 89 F <br />ra ;W S Lt[ntiati_ <br />.L1ies�e1 Di <br />turn Lxtrtion: .Y * K' 1N t <br />A r' Sutra Lacution_ <br />7 S i!! containment suuct>rtes ate free of water, debTis, and tsuzanlow atKtante. <br />Y N NA <br />Tank I - Contents: 91 y�c ] r Taut 3 - Contents; <br />87 , r <br />Tank 2 - Cantentr: 84 Tank 4 - Contents. Diesel <br />t� txler�IiS C(tntAsmm�r5t $rqS am frcc Of water debris, and hazardOus s'nbstanee. Sensors are located asci . <br />Y N NA, -7f N NA <br />l)is user 1 /77-- ! D- .riser 9110 <br />Din user 314 I]1s user 11 / i <br />Drs naer 5,16 Dtspenser 13! 14 <br />Dispenser 718 1?i ri r S <br />sp�e se 1 ! Id <br />APE <br />ix�vxK [NSP�C�iloly , , � x NA DATAE DaNE <br />9 Monito P <br />sy m Cer&fication has bem completed within mst 12 alumhs. <br />H) Semon contarrtmctrt tests ha ?e been ca_ mpleted withita the airedtfinefi7mic <br />11 I containment str� tmlmg rme (bucket'WW completed WAhm the ear. _r _;, v d!)12 Tanta ti test ax was cx! <br />within r tin rame- <br />13 Line t wast er1 within xairecl timefinme. <br />14 Oilrcr uirr" tesi�n enanc was CO leted within tenured timeframe. (Gist testImajntenance items below.) <br />7est1AfaintenanCe- Leak!`7eAmYon fCrr <br />Test/A�ainferratrce: ' <br />!"est�ltrin tenarrc�: <br />.. . -.... r„ c i, c :�. .,., .•5u . ,''re's ;,, ',.. ;.-. n -.r w^= . ryv ..r. <br />FACR-.T1"'ll EMPL0j Xlg TRAHW(G Y NA <br />Ia AI! facili emplo es have rtceived the mired an the jv(t txainin withinthe <br />15 All faci!i MP12yecs hired within tale past 30 days have re=cdved the on -the b training <br />Notre: Any answeref "N", Amid be explained in the comment seedon air <br />followv-up aetioo. tip following page, and will require <br />Page 1 4f 2 Novenibtr 2004 <br />SI/L9 3E)Vd hTLIISO 8bT666S-6ez bE:LO TTK /6Z/Z6 <br />