Laserfiche WebLink
Shirley Environmental Testing, Corp. <br /> Designated Underground Storage Tank(UST) operator <br /> M©nthl V' <br /> Fac'lit Name: S Y Isual ]nspectlon Checklist <br /> Facilit Address: Date: <br /> r a ,cf <br /> Cit : f� <br /> Desi ed UST tnr Canductin theCode: <br /> Internationale I Ce <br /> on <br /> iration Date' / I <br /> lanae:{ - <br /> ittCm Y�Y N=No NAS <br /> MONr["C)RING PA L/ALARM ffiST+ORY Not A Hcabtc <br /> 1 Monittorine em is veered oa and, Y N NA <br /> 2 Morita ' stets is txot made. <br /> 3 Alarm y the <br /> hist ct ntl showin alarms or warnin <br /> ' poti/log for the previous month is available,and has mewed h <br /> Desi ated UST Q rotor. Q(tach a co a the alarm histo re rtdlo to this arm i ava7lahle, <br /> Each alarm for llae ous month has been nded to <br /> 5 Sensors looted in tank=to eo r° <br /> ntainment have not ast month. <br /> Sa - List all tank-top sumps where alarms occurred in the past month: <br /> Note:Sumps where an alarm has oc-mid in the <br /> Properlyaddressed,the cause q'&-almm.tlitaah doeummeratatfon be f ,ed a17Ws a <br /> I sum ins lion is r lred reco rearllr ltr fpm 6,below saw0ied service�hrdcian <br /> le�n8 aPP 'ale aerYlGresponded to,and <br /> E to this report <br /> IIST SYSTEM INSPECTION <br /> Tank top containment sumps ate free of hater,deb <br /> Note:T�auul in flan o srf- "a is un redtn SUM mlr ra daus Is wan De. Set 1 S e located properly. <br /> accirrre rlin the rtmonifi orWhddh there is no serty raecorrl <br /> Sunt Location: d Y N <br /> Su Location: <br /> Sven Location_ <br /> Sunt Location: Sum Location: <br /> 7 S illcomtainment structures are free of water, Sum Location: - <br /> and hazardous substance. <br /> Tank 1—Contents: Y N NA <br /> Y N N <br /> Tank 2—ContentsTanis 3—Contents• <br /> UTank 4--CantenGr.• <br /> i <br /> 8 nder ser con#ainment areas are free of water,deb <br /> rig,and bazardcws substance. Sensors are located <br /> D Ener 112 Y N NA <br /> Di eraser 3 J4 Di ertser 9110 Y N NA <br /> Dr eraser 5 J6 Di eraser ll Jl2 <br /> Di nser 7J8 Di eraser 13/14 <br /> Pis ser 15J16 <br /> PAPEBW(}RB TNSP`ECT UON <br /> 9 Monitatin em cer#ificcation has been corn leted within N NA DATE HONE <br /> 10 Seco containment tests have been w leted.within the 12 months_ o <br /> 11 S ill containment stracture(bucket)fes ' was ca utteci Vie. <br /> 12 Tank ti ess testing was completed within r lete[l within ilae ear. <br /> 13 Line ti ess testis was ry Ieted within cited timeframe. <br /> 14 Other uirerl <br /> lesttlam irrle�anro tggg TJri re <br /> letedvath- <br /> Test/Mairttenance: timeframe. (List test/maintenance items below.) <br /> Test/Maintenarlce: <br /> TesbMaintenonce: <br /> FACILITY EMI'IAYEE TRAINlI11TG <br /> 15 All facili em to ees have received the Y N NA <br /> 15 All.facility a to s hired within the 30 ed an-the-• trainin wilhia the - <br /> days have received the ort-the 'ob trainin . <br /> Nate: Any answer of"N"should be Ci plained in the comment seetion on the following page,and will retluim <br /> follow-rap action. <br /> Shirley]Environmental Testing Corporation <br /> 9595 Lucas Ranch Road,Suite#100,Rancho CucamonA CA 91730 <br /> 800-533-4030 <br />