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11/06/2007 TUE 12;0.9 FAX 209 937 5846 12014/016 <br /> • Environmental Corporation <br /> Designated Underground Storage Tank (UST) Operator <br /> Monthly Visual Inspection Checklist <br /> Facilitv Name: r"; P GL-- Facilily Name: <br /> Ricility Address:_4V�,O_-1 <br /> Ci tv: i Code: <br /> r. <br /> Designated UST Operator Cond acting the Ins nection: <br /> — : 2 12 c' <br /> 17 177=iration Datc <br /> I International Code Council Certification#: 1`-,i. 44 'IT <br /> Signature: Phone: i <br /> V=VesN—Nio,NA=Not Applicable <br /> , <br /> Item MONITORING PANEL/ALARM HISWRY Y IN NA_ <br /> I Monitoring system is powered oil and in proper operating mode. <br /> — <br /> 2 5Z_nitoring system,.is not currently showingany alarms or warnings. <br /> 3 Alarm history report/log for the previous month is available,and has been reviewed by the <br /> Designated UST Operator. (411ach a copy of the alarm history reporliog to this fornp if available. <br /> — res ended to aplRriately, <br /> 4 Each alarm for the previous month has been )ro <br /> 5 Sensors located,in tank-top containment sumps have not alarmed in the past month. <br /> 5a List all lank-top sunips where ala717123 OCCUITed in the post nlol?th: 0. !­J <br /> Note:st(rups u,jrere air alarm has occu?TVI 1110 POSI rilopith ni iisf be inspected wiless a qualffied servfre technician responded <br /> to,and properly addressed,dre cause of the alarm.Affach docronentation verflinz appropriate ser"ice to lh's <br /> if surup inspection is required,record results itein 6,befout <br /> UST SYSTEM INSPECTION <br /> 6 Tank-top containment sumps are free of water,debris,,and hazardous substance. Sensors are located Properly.I/,for.i0i0i there is iroservice reconi. <br /> I mat, ija.s occurred fir the cast nioti <br /> Note: Visit,71 inspection ofsunips is otill,mqWy in sum M whem an a <br /> Y I N Y N <br /> SutnpLocafion.-o4,,,-,- <br /> Suinn Location: <br /> SU Location:,,�',\ <br /> Sunin Location: <br /> Surra Location: <br /> 7 SPill containnient structures are free ol waten debl'is, and hazardous sy bstan ce. <br /> *Y I N INA YTN-F-Nl Al <br /> Tank 3—Contents: <br /> Tank 1 —Conten ts: V3 ut li r�r i <br /> A Tank <br /> 3 <br /> Tank 4—Contents: <br /> Tank 2—Contents: 0�, I substance, Sensors are located oro erly. <br /> 8 Under-dispenser containment areas are free of water, debris,and hazardous Y N NA <br /> Y N NA <br /> Dispenser 314 Drs enserl/2 <br /> Dispenser 11112 <br /> Dispenser 516 Dispenser 1311-4 <br /> Dispenser 718 ser 15116 X <br /> PAPERWORk INSPECTION Y NL_ NA DATE DONE I <br /> 9 7 Monitoring system certification has been completed within 2ast 12 months. <br /> 10 i <br /> Seconds ry containment tests have been coca pleted within the required time framc. <br /> n�t year,n <br /> 11 Spill containment structure(bucket)testing was completed within the <br /> 12 Tank tightness testis Was Com lete,]within roquir d time frarric. <br /> 13 Line tightness testis I was completed within required time frame. <br /> —­61—her required testingh-naintenance was completed within requ ftainc. (List aw, 12�:e items below) <br /> 14 <br /> TestlMaintenance: <br /> Test/Maintenance.` <br /> Test/Maintenance: FACILITY EMPLOYEE TRAINING V/ N NA <br /> as an <br /> A facility employees have received the required on-the-job training within the past <br /> 16 All facility employees hired within the past 30 days have received the required on I )b training. V <br /> Note: Any answer of'IN"should be explained in the comment section on the following page,and will require follow-up action. <br /> Page I of 2 <br /> Shirley Environmental Corporation, 9595 Lucas Ranch Rd., Ste. 100, Rancho Citcanionga, CA 91730 <br /> Tel:(909) 476-7443 - Toll Free: (800) 533-4030 - Fax: (909) 476-7114 - CA Lic. #814027A HAZ <br />