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Q008/016 <br /> 11/06/2007 TUE 12:08 FAX 209 937 5846 <br /> Shirley Environmental Testing, Corp. <br /> Designated Underground Storage Tank(UST) Operator <br /> 0 Monthly Visual Inspection Checklist <br /> Facility Name: Dat- 2 <br /> FaciULy Address: I <br /> zip 92d�C, ' <br /> City: US <br /> Desi ted UST Operator Conducting the Insv W- 11011: 3 <br /> E . tion <br /> JC te- <br /> Date: <br /> l�ternationaIC(o)de,Counc.itCerLification#:. '�'.�., <br /> Phone: <br /> Signature: <br /> LZ Y-Yrs,N=No NA-NUA 11cable <br /> Item MONITORING PANEL I ALARM HISTORY Y N NA <br /> stem i oyl=oji an <br /> 1 Monitorings n and in proper operating mode. <br /> aSt=is PDWCrCd 0 <br /> tern is not 'atly S <br /> on n8 s ' <br /> tor <br /> sb or warnings. <br /> 2 Monitoring system is not mu'rClatlY Owing EX alarms'm 'q <br /> Item <br /> Alarm history i-eport/109 for the previous month is available,and has been reviewed by the <br /> Designated UST Operator. (Attach a copy ofthe alarm histar re rtfiog to thtsLortn jlavailable.2)_ <br /> rop <br /> 4 Each alarm for the ; <br /> .previous month has been responded to a <br /> havp <br /> 5 Sensors located in lank-top containment �Sbave not alanned in the ast month. <br /> Sa_ List all tank-top.sumps where alarna occurred in the past wonth: <br /> n <br /> Note:supiips where on alarm has occurred in he pas,Inonfil must be!?jjpected unless qualifled service fac responded nded to,and <br /> properly addressed,the cause of the alarm.Attach docianmtotion seri ng appropriate service to this report' <br /> ,limp fns coon j.c required,record results item 6,below � <br /> T SYSTEM INSPECTION <br /> free of water,debris,and hazardous substance. Sensors are located properly- <br /> -* <br /> 6 Tank-top containment sumps are f rm has occurred in the past month r which there is nod ice record.Note:v 7s is-phere an fo <br /> Visual inspection ofsumps is:only re z <br /> N <br /> Sunt Location: is s SumLocation: <br /> Sump Location: <br /> StimpLocation: <br /> Sunt p Location: <br /> Sump Location: <br /> 7 Sial containment structures are bw of water,debris and hazardous substance. Y N INA <br /> Y N NA <br /> Tank 3-Contents: <br /> Tank I -Contents: Tank 4-Contents: <br /> Tank 2-Contents: Sensors are lo Y. <br /> 8 'Under-fflspenser muent areas are free of water, s,and hazardous subs Y N <br /> NA <br /> Y N NA <br /> Dispenser 9110 <br /> Drs Eraser 1 2 i_ 'Mi: - <br /> X <br /> Dispenser 3 4 2, Di 11 spenser 11/12 <br /> eraser 13 114 <br /> Dis e <br /> P <br /> Dispenser 5 6 n;-­­serl5116 <br /> Dispenser 718 <br /> Y N NA DATE DO <br /> PAPERWORK INSPECTION <br /> r <br /> M�AT <br /> 9 Monitoring system certification I=been completed within p�st 12 months. <br /> 10 Second containment tests have been completed within the aired timeframe. <br /> in containment structure(bucket)!es�lin was comp ed within the,past year. <br /> 11 <br /> 12 Tank fightness testing ly— v fimetmme. <br /> V, timeframe. <br /> 13 Line tj�tness testing was completed within requixod tinief <br /> T4 Other r Hired testin n7aintenance was completed within Leguired timeframe. (List tes(Imaintenance items below.) <br /> _ <br /> Test/Maintenance: <br /> TestlMaintenance., <br /> Test/Maintenance: <br /> VACH,yry EyEpLOYEE TRAINING Y <br /> N <br /> NA <br /> 15 All facility employees Dave received the required on-the ob training within the past year. <br /> I <br /> 16 All facility Employees hired whiiin the past 30 days have received the required on-the-30b Mining, <br /> Note: Any ans.w-er I of"N"should be explained in the comment section on the following page,and will require <br /> follow-up action. Shirley Envirownenial Testing Corporation <br /> 9595 Lucas Ranch Road,Suite#100,Rancho,Cucamonga,CA 91734 <br /> 800-533-4030 <br />