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i 0 j<�4�1 <br />Designated Undergromd Storage Tank (UST) Operatar <br />Mev visual Inspection Checklist <br />tel"Fl ri _Qvclr-m is nnwrnnd rrrr arui in rFrlT)&.r onEr aline ! ode' - <br />2 <br />Monitorin is not caRren showin alwms or wanun <br />Facility Address' `s � C� rJJ,I� <br />3 <br />Ci <br />_LZvp Code- <br />nesiguated UST Operator Co the w John D <br />Each alarm fpr the ptmous month has beau to aly <br />International Code Council Certs - #8000563 - VC <br />f Ep- tion Date` November 24 2011 <br />Si <br />Phnom, ( 916 ) 217-1373 <br />tel"Fl ri _Qvclr-m is nnwrnnd rrrr arui in rFrlT)&.r onEr aline ! ode' - <br />2 <br />Monitorin is not caRren showin alwms or wanun <br />3 <br />Alarm history reportAog for the p r% ions month is available, and has been reviewed by the <br />Desi ed UST or, Offachr a e o the alarm history re to [Msform i available-% <br />4 <br />Each alarm fpr the ptmous month has beau to aly <br />5 <br />Sensors located in tank -top OolltaittYa ml suMs have not alarmed in floe Past moWL <br />5a <br />'st alt tank -top sumps where atoms occurred in the past twnth: 'TO <br />PUP` J <br />Note: I-mnps *hare mt ala»» hpb oLwumo i in the post mpnr ~be inaprc" an%ss a q"Of ed service ischnimm reuponded-.b. and <br />properly addressed the emum of ttae alarm Aawh dacwmmtation rerif" appraprlale j-OvW to rhls repon <br />rrt ,tion- is rap rred, record —hr in J— 6, below. <br />u^y,.•,3..� <br />-x w• i�M! 'rare. - ,k'n:rl L+�,d.. ict.-:M:Y- .,.+], i+s3: �,tv 57.1'., h:t„d._y;..� �..r_�. <br />-?.Ca•o?; <br />UST SYSTEM INSPECTION <br />fi <br />Tank -top containment sumps are free of water, debris and hazardous substance, Sensors am located properly. <br />Ware: YIsual ins rion srax s is rn sump s where an alarm has oexvrW in Me sr mo 7th w which there is no service record <br />Y N r° , Y <br />Sum TO91 Sulu Location. 87 <br />Sum Location: 89 .iwn Location_ Dieser <br />gum Location_ i q Skanp Loeadon: <br />N <br />,vlc�r�v�o <br />, r. <br />7 <br />spill containment stracturts are free of water, debris, and hazardow mbstaace <br />" Y N <br />NA <br />Y N <br />NA <br />Tank 1- C�intents • e, 1 - <br />Tank 3 - Contents- 7 <br />Tank 2 - Contents: 89 <br />Tank 4 -('An ntrz iesel <br />8 <br />Undm - corMunment areas are f m of water, debris, and ha&ardous substaace. Seusors are locates propcdy. <br />Y EUA Y . N <br />NA <br />Die r 1 /,Z. e c- . Dispenser 9 / 10 <br />DaVwnser 314 DiTeneer 11112 <br />Dispenser 5 /6 Di ser 13 / 14 <br />Dispenser T Dispenser 15 16 <br />follow-up action. v <br />LT/60 -JCJ <br />Page 1 of 2 <br />November 2004 <br />0 <br />PTLTISO eVT6669-6K CV:L0 TIOCIE6160 <br />