Laserfiche WebLink
0 <br /> Shirley Environmental Testing, Corp. <br /> Designated Underground Storage Tank (UST) Operator <br /> Monthly Visual Inspection Checklist <br /> Facility blame: Ci. Date: <br /> Facility Address: ® , <br /> City: C#� Code: <br /> Desi ed UST Qpprator Conductin the on: A1� <br /> International Cale Council Certmcation#: �C, iration Date: <br /> Si tare: Phone.( 64572 <br /> Y='Y lel=NnNlA-NotAppOcable <br /> Item MON1TOMG PANEL/ALARM HISTORY Y N NA <br /> 1 Monitorin m is weres3 on and in mode. <br /> - <br /> 2 Mani tonin em is not cuuentl sltowin an alarms or warnin <br /> 3 Alarm history reporoog for the previous month is available,and has been reviewed by the <br /> l]esi aced LIST O rator. Attach a co o the alarm histo re rt4o to this otm i av�lable. <br /> 4 Each alarm for the previous month bas been TrSPonded to apropriately. <br /> 5 Sensors located in tank-top mntainment 2TTps have toot alarmed in the past month.. <br /> 5a - List all lank-tap sumps where alarms occurred in the past month:_ AJ 0 L <br /> Node:Sumps where an alarm has occwmd in the past month mist be tnsp®etrtd unless a qualified service technician responded pati <br /> properly addressed,the cause of the alarm.elttach documentation i�enfydn$aPprgrn late aeFvice to this report <br /> I sum ins ritm is r Bred,record results in it1,n 6,below. <br /> UST SYSTEM INSPECTION <br /> 6 Tank-top containment Amps are free of water,debris,and hazardous mbstance. Sensors are located <br /> Nate:irsuai i tion o sum s is red properly. <br /> In surn a where an alarm has accstred in the st month or which!here tsnoserval <br /> Y NCe rp-cord- <br /> Y N <br /> Sum Location: Sum Location: <br /> SuM Locatron: SUMP Location: <br /> Supip Location: <br /> Sump Location: <br /> 7 S ill containment stractures are free of water, ris and hazardous si bstance. <br /> Y <br /> Tank 1–ContentsN NA.- 'rank 3–Contents.- Y N NA <br /> Wank 2–Contents. Tank 4–Contents.- <br /> 8 <br /> ontents.8 Under-dispenser contai "Cut areas are free of water,debris,and hazardous substance. Sensors are located ro era . <br /> Y N NA Y N NA <br /> IDinser <br /> " r]J2 Di riser 9110 <br /> p r 3 l4 Di enser 11/12 <br /> i r S/6 Di enser 13114 <br /> 718 Dis ser 1S/16 <br /> I <br /> PAPERWORK SPEC ION Y N NA DATE DO <br /> I 9 MclutOnng sYstem certification has been completed within past 12 months NE <br /> 10 Sowndary containment tests have been conipleted within the=quired timeframe. <br /> 11 S ill containment stricture rb—I—N was co feted within the Par, <br /> 12 Tank ti testniz was completed within E2gaiLe4 timeframe. <br /> 13 Line ti tress t­f;ner was COraDleted within Mquired fimeframe. <br /> 14 Other uised testi- maintenance was oa Ieteti within timcfiame_ (List test/mainten ce items below.) <br /> Test%Maintenance: <br /> Test/1l�aintenance: <br /> Test/Matnfenrrnce: <br /> IFACII.ITY EMPLOYEE TRAINING N NA <br /> 15 All facili em to ees have received the Mwed an-the tr$i-in within the past year. <br /> Y <br /> 16 Al]facility employees lured witlem the past 30 <br /> days have received the on-the-job ttainin , <br /> Note: Any answer of"N"should he explained in the comment section on the following paw,li,u'will require <br /> action. <br /> Shidey Environmental Testin&Corporation <br /> 9595 Lucas Ranch.Road,'Suite#100,Rancho C=mo,,A CA 91730 <br /> 804-533-4030 <br />