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<br />0
<br />Designated Underground Storage Tank (UST) Operator
<br />Monthly "visual Insvectaon Checklist
<br />F Namc- ,'
<br />Date f
<br />Facility Address: /Y" [ rc/
<br />:;', �. _•.,re,rxc. a.:r-, �•�• .+�,. F ti h n:. ..� ..¢n -f Er ah ,.F, J,Ky',.r 'ti v., y`0..3.,q A'iay _
<br />�pqMcred
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<br />Z" Cade:
<br />DesiDiated LIST Qpuator Conducting the Jahn Oale
<br />2NtheManitormg
<br />l Aamtional Code Canartt itGa # 8040963 - C
<br />E iration Date' Ndvwbu 24, 2411
<br />Si
<br />Phone, ( 916217-1373
<br />V - Ve9, N - No. NA+Not AunticaMe
<br />Item -
<br />_. r eyucu fl7S IIon zRM S 1S amra sx
<br />MONIftftlG L f ALARM TBUSTORY � Y I N NA
<br />u � ro,
<br />:;', �. _•.,re,rxc. a.:r-, �•�• .+�,. F ti h n:. ..� ..¢n -f Er ah ,.F, J,Ky',.r 'ti v., y`0..3.,q A'iay _
<br />�pqMcred
<br />1
<br />l nitoLna ystem is on wd qLmW pperauqg mo&.
<br />Y l
<br />87
<br />2NtheManitormg
<br />system is not C1Ir[1e'W Sb�wuag M alar or �V8In1IlgS.
<br />Sump Location_
<br />3
<br />Alma history rort/log for tate prevKm montb is availaWc, and has been reviewed by the
<br />t)
<br />Sump Lr�cnn:
<br />��
<br />—
<br />17e.�w tJST (�rtth a ca O the raJararr hist re to thisfoa ate i available-%
<br />debris, and hxrArdowsubstuice.
<br />4
<br />Each alarm faa ttmp O has been led to
<br />N NA
<br />5
<br />Sensors tot ed in wik-jop cot Wnwe a shave not alsruttd in the month.
<br />3a
<br />List aJl tank -lop sumps where alarms occurred in the part month: %-
<br />Tank 2 - Contents: 89Cvn#earJs:
<br />•^"^ KGaI . _. nS�/1.�. ry1 .,_K'7iA.Y/ /7x I. `4.�=".i 4,x'1-_�-�'Y1 N��_
<br />•
<br />Nati.' SSn►xpr whsre an alra� has octiwrrad in ateeiaasr nuaah �� be inapec7e�1 urhlesa a yualil"red sQr,nce techrr3rlan res}xrndeed to, ""�'�'�
<br />'1r
<br />property addresra�i rke cause of rhe odarIIc littuch dctv�in wpY�yblg nPP��+ate asivl'ce to eMts r�pvrt
<br />_ StusorS are located ra
<br />! arhrn inr cricM is d, recortd rfalfs nr Rena tre3ow
<br />e. �-
<br />.. ,::� . �,`C:r q;, ?t;':µw y F'.,;%h: ., `�• � .9: �'' M`Lr b:..M'9:{:W�r ! G r.-
<br />'l+r<'^;�.wl. ,
<br />.
<br />usar :�Ys�l� rns��cT�arr
<br />6
<br />Tank -top cdritairruaent %np are fi= of water, debris, and substanra
<br />_. r eyucu fl7S IIon zRM S 1S amra sx
<br />s Asre an alarm has occurren the
<br />d ih
<br />st —nth or which there !S ;7o rervlcx
<br />Surra LocatioJa: 91
<br />Sett ocvtron:
<br />Y l
<br />87
<br />Sum L.ocation:. 89
<br />� ��`'
<br />Sump Location_
<br />Diesel
<br />Loeation, F'"
<br />7 S ill containment stru� are free
<br />Sump Lr�cnn:
<br />��
<br />—
<br />Of water,
<br />debris, and hxrArdowsubstuice.
<br />Y
<br />N NA
<br />Tank 1 -- Corrtertls: 91 .
<br />Tank 3 - Contents—_87
<br />Y r
<br />Tank 2 - Contents: 89Cvn#earJs:
<br />•
<br />_
<br />Diesel
<br />8 Under eaa r containment areas are free of water, debris, and bazardous
<br />'1r
<br />rubra.-
<br />X NA
<br />_ StusorS are located ra
<br />i77S nser' r• ,p Dispenser 9/10 Y r i
<br />Di reser. 3 / 4 Dis area' 11 ! 12 —
<br />Di user S"! Di Unser 13 11-4
<br />d.z D��petrse�IS/1t5
<br />1'li�izRWURY{ irTSP)C' CTY41�i r..,.,+,r y .r:.\.s.e,•
<br />9 lvlani%ritx stem c
<br />cent G9Wn has beer► completed 1xidtin i 12 monihPs_ Y NA DATE
<br />1D Seca eantainment tests have been—
<br />1 } S ill containment caarrpletecl within the r aired
<br />strrrct:se 111 ---F i was completed within the pag
<br />12 Tank ti tvas leta�d within
<br />13 Lige tz ess ` was Camlrletcxi within
<br />14 OtherrEquirul tcstin t requued
<br />ince was conn ctad nithiu rcqi
<br />Test!/[fcrinterraxzee: Zecpic De#eafrottisf fest/maintenarice iferras &elc
<br />7'est/Afaintearmmee:
<br />2'estld �qi n t en rm c e;-
<br />,,... .i4Y lye; .lel• w'., RI!T:'Y(..
<br />. rlcC'S. ,WIJ r r 'itrP:t 7}..x
<br />15 All iaciLi crit td tics have received FA�1'I'' E�PLCI IIKj]�rG
<br />the t>n e "ob withi>z
<br />16 All fscili eat 1 ees hired w iibin the t 3t? d$ have
<br />- Note_ Any answer of "N" Bhcauld be � received the
<br />fotiovan er . exo d in the comment secUan on the fa
<br />Page 1 of 2
<br />NA
<br />N NA;
<br />ar,
<br />uPr-'db tr '
<br />Pam aad will require
<br />NOvember 2004
<br />5T/TT 39VJ VILTISO 3#T066S-607 PC:20 TTK/6Z/Z0
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