Laserfiche WebLink
Shirley Environmental Testing, Corp. 0,27 10 <br /> Designated Underground Storage Tank (UST) Operator <br /> Montbly Visual Inspection Checklist <br /> Facility Name:SPa4 ,,v r - Seo KTD c-T 7u11"TC} nate: 2 ,12 _ 0 <br /> Facility Address: r C�nJA C] <br /> Cit : C'& Zip Code: -9 .;Z C <br /> Desi ed UST Pprator Conducting the on: lf� , QM <br /> International.Code Cogncil Certification : d - U C Expiration Date:1 21 1 a 005 <br /> Si attire: Phone:( Q 7�a- -4 9 <br /> Y-):MN=It NA- 'ctApplicable <br /> Item MONITO><tlNG PANEL 1 ALARM WSTORY YN NA <br /> 1 Monitoring system is powered on and in pro operating node. <br /> 2 Monitoring system.is not currently sh_owin an ahirms or warnmi <br /> 3 Alarm history repoMog for the previous month is available,and has been reviewed by the X <br /> Designated UST Operator. Attach a co the alarm histo re rMo to this form if available.) <br /> 4 Each alarm for the previous month has been respgrided.to a pro riat <br /> 5 Sensors located in tank-top containment sumps have not alarmed in the past month, <br /> 5a List all tank-top sumps where alarms occurred in the,pastnionth: <br /> Nate:Sumps wherean alarm has occurred in the past monrh mutt be inspected unless a qualified service technician respanded to,and <br /> properly addressed,the cause of the alarm.Attach documentation iwifying appropriate service to this report. <br /> t scan fns "on is r `red,record results in item b,below. <br /> UST SYSTEM INSPECTION <br /> 6 Tank-top containment sumps are free of water,debris,and bazardous substance. Sensors are located properly- <br /> Note:Visual inspection? sumps is only regaired in sumpswhere an alarm has occurred in the past month or which there is no servfeq xrmrd <br /> Y N Y N <br /> Sump.Location: LD Sum Location: <br /> Sum Location. - :: Sump Location: <br /> Sump Location: Sump Loca#ion: <br /> 7 -spin containment structures are free of water,debris and hazardous substance. <br /> Y N NA I Y N NA <br /> Tank 1--Contents: Tame 3-Contents; <br /> Tank 2-Contents: _ Tank 4--Contents: <br /> 8 Under containment areas are of water,debris,and bazardaus substance. Sensors are located properly, <br /> Y N I NA Y N NA <br /> Dispenser 112 Dip enser 9110 <br /> Dispenser 3/4 Dispenser 11/12 <br /> Dispenser 5/d Dis enser 13/19 <br /> Di ser 718 Dis enser 151 I6 <br /> PAPERWORK INSPECTION Y N NA DATE DONE <br /> 9 Menitorinsystem certification bas been com feted within past 1.2 months. )< -- <br /> 10 Secondary containment tests have been completed within the required timeframe_ <br /> 11 Spill containment structure(bucket)testing was completed within the past year. ,t i�Cn1U z�_r•� <br /> 12 Tank tightness testing was completed with required timeframe. <br /> 13 Line tightness testing was cornpletod within Yeguired timeframe_ x1 <br /> 14 Other aired testis maintenance was cam feted within timeframe_ (List lest/maintenance items below.) <br /> 1"e3't/1Lfaintenance: <br /> Tesi%Maintenance_ <br /> TesLMaintenance: <br /> FACILITY EMPLOYEE TRAI UNG X N NA <br /> 15 All facility employ=have received the repffcd on-the-job traming within the past year, <br /> l6 All facility <br /> employees hired within the past 30 days have received the required on-the ob training. <br /> Note: Any answer of"N"should be explained in the comment section on the following page,and will require <br /> follow-up action. <br /> Shirley Environmental Testing,Corporation <br /> 9595 Lucas Manch Road, Shite#100,Ramcho Cucamonga,CA 91730 <br /> 800-533-4030 <br />