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Designated Underground Storage Tank (UST) Operator �/;�,P <br />Mon"Y 'Visual Insp�tion Checklist i�� <br />- li Name: Chevrots <br />„ <br />F1i Address: <br />�_.. e��•v� _ ..i Gide:' _... <br />Desi Mated UST,Operator Conducting the Iris ction: John Dale <br />lnteraational Code u it Ceriific 863 >rx iratian Date: 11.f24/ f1 t 1_T__^__ <br />signature:_ Thane: 916-217-1373 <br />'y' - T. NV = N 1VA =.Not r4 ito i� <br />Item <br />. �R TORY <br />Y til l�A <br />MCINITClltll�G f't# EL 1 Al.r _ <br />,.,, o <br />�I llrfxi>tll 11t1 is 1�_ on and in tt O-r o :6rd+ mode. _ -- <br />2 Ivfanitorina s stem is not current! shativinl ani alam _ or warnings. <br />3 Alarm history report/log for the previous month is availablc, and bus been reviewed by ik�e <br />1]es' Hated U5T O erator. (Aitach u cis o 'lhe aiarm histor re crCilo ra lhtscsrn± i rrvaila6fe. r,Ji/* <br />$ `1y€tGh alarm torr the. reviews month has been feSp.onded to appropriately,.. �,. <br />5 Sensors located in tank-t4 Containtr►ent sum shave not alatTrsed in the. est month. . <br />5s Lisr all rank�rop sumps where alarms nccxrr•ed in the plisl ir�ontia: t`.� /:�r,',,,�.��s,�.��� ;.�� ,CG� <br />mac.. <br />None:' $'tnnps where ors alurrn !teas 4CCtlrred in o► a pasi manth Hive be inspeCrBd unless a qualrrjed service technician responded to. and <br />properly addressed,, the cause of the alann. rllrpch pocunten[atian ver�in� ap}�ropriate servrCB tri rhts report, <br />ist `i . ixr recur resrtlts I`rr un d belogv. _ <br />r + . +', a171T i <br />WSW Wall UST SYSTIEM INSPECTION <br />6 Tank-top containment SUMPS are fret of water, debris, and hazardous substance. Sensors are located ga openly. <br />jiale: Visual in Coon G LSNna S is on re ired ril gi qpr iohgre a- alarm has ecurrea inthe Dan MonthLar arhi h there is o sell icc retard. <br />N res Y } <br />,Sump L ocation; Tf �� Stem LoGa#ran 91 <br />Sura LocaPion: 87#2 S'tlm Location: Diesel <br />Location c I',i} Jnr` Localton <br />7 S xll. containment structures are free of _4- N N` <br />Sum _ Lo - <br />� N NA haiardoiss substance, A <br />Water dts6Yt�: attd -.—.M.-�...... . . <br />Tana 1 ..CQn#ert# 1 nil. :12n}c 3 Conter7ls: <br />i'anlc 2 Gantei rs: 87#2 or 89 ' ud" ; 4 - .Contents: ,9.1 Diesel r <br />,�dolxi and iazar¢aus siib t ce..seasoxs are.ipeated �t`�• <br />of.� <br />N. <br />it tr; - s .CAittaixrment re s.are 1' hl NA AA . <br />is enser l 12 M.errcer ii f 12 <br />6 <br />arisen 3 <br />Dis eraser 15 / 1 <br />DfS 1 � <br />6 <br />Dis enser,5.f tri <br />Dis user 7 8 <br />Dispenser . �' <br />D. i easer 191 0. <br />Dis �rtSr..(1(1 PAP1EIf�V , <br />1�A iasiT� D[?lvil; <br />__.... YNSpECT�YCIIV <br />coats certificatwtt has 17ccn tom lctcd within,past 12 montk�s. f <br />9 1Vic�t7rt�rui s sterns 'lam —t <br />1.0 Secpndar imnent tests have been cornpieted within tine regtrired tirraefi rrie. <br />w{ <br />1 I li:contain cent structure buGlce W$tin was ca lcted ithin the ast °ear._ <br />was com .leted within re. uir.ed timeframe, <br />12 Faukc ti ttiess tesi' wtiin ,i` u <br />.- . <br />13 Line. Khtness <br />l�} OthEs# ut( iltt gtsti xil lilt likde was Citi r lett e W d i-_---� � t� d ti�ntra� tQsb'nt mance t#erns.�e�erw: <br />., <br />Tesr/h�alnteriartce: DSD testin was col feted wiihin there m� <br />Testlhlain#er�rmce,• <br />TestiMarrzfcnc#;�e:° <br />N. ' NA <br />15 li feel!It $1 l 5 have received the r ri�setl an the t3 within the S Mr,. <br />-� is All facili e:m to ces hi .ecl within the est 3D da s have received the r ttzl oA thte pb train _ <br />Notes Any answer of "IV" should'6e egplairied in t3ie corument section on the following page, and will require <br />follow-up action. <br />page 1 of 2 November 2404 <br />LT/ST 3DVd bTLTISO 8bT066S-60Z CV:/-O TTK /EZ/Z9 <br />