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11/06/2007 TUE 12:06 FAX 209 937 5846 <br /> Q002/016 <br /> Shirley Environmental Testing, Corp. <br /> Designated Underground Storage Tank(UST) Operator <br /> Facili Name: Monthly Visual Inspection Checklist <br /> Date: <br /> Eacilit Address., <br /> Ci <br /> 17'p Code: <br /> Desi ed UST Onemlor Conducting the Jus ection: <br /> International L;Ocle Council Certification <br /> Ex 'ration Date. <br /> Si afore: <br /> Phone: <br /> Itcno --------- NA-N <br /> MONITORING PANEL I ALARM HISTORY Y N <br /> NA <br /> I Monitor M- ry qvstem is powerM on andinproper operating mode. <br /> 2 Monitoring steal-not-currently showing any alarms or warnings. <br /> 3 Alarm histoly rcPoroog for the Previous M011111 is available,and has been reviewed b the <br /> Desi rator. (Attach a 9f the alarin <br /> 10"J" 1-1411"U'11'�Mpy <br /> history re <br /> )yj-bq9g to this form if <br /> 4 Each alarm�for the re'*Wus Tn0-nU1 has been res nded to appro riately, <br /> 5 Sensors located in lank-top coatal—nmeni­SUMPS have not alarmed in the past mouth, <br /> 5a List all tank top sul"Ps where alarms occurred in the past month: <br /> 'Vote:911111ps where an alarm has occurred in the past nnonrh n2ast be Inspected unless a qualified service 16chniclOnresponded to,and <br /> properly addressed.the cause afthe alarm.Aftoah documentation 1talifong app ropriot,se?vlce to this report. <br /> r5repaired,record results in item6,below, <br /> UST SYSTEM INSPECTION <br /> 6 Tank top containment sumps are free of water,debris,and—11a7 <br /> Note.-Xsual inspection afsyrnps is and ardougsubs,ance. Sensors are located properly. <br /> 2requiredt'?Mn? s Where an alarni has occurred in the Pastmonth rorwhich there is no service record. <br /> sum ocatioll. y <br /> surn?)Location: <br /> _qymE Location: <br /> Sump Location: <br /> Sunt Location: Sump Location: <br /> 7 %11 containment structures-arefTec�of water,debris and hazardous substance. <br /> N NA <br /> Y N NA <br /> Tank I-Contents: Tank 3-Contents.. <br /> Tank 2-Contents. <br /> Tank 4-Contents: <br /> 8 Under-dis—enseT corrt<rininent areas are free of water,debris,and hazardous substance.-Sensors are located ro erly. <br /> Y N N located <br /> ro er'y, <br /> N �A <br /> DJs eraser 112 N NA <br /> D)i — , , i, eraser 9/10 <br /> is enser 3 4 V- Pi�enser 11 12 <br /> Dis enser 5/6 <br /> eraser 13 1,f— <br /> i eraser 7M— D ispenser IS/I6 <br /> PAPERWORK INSPECTION <br /> Y N NA D DONE9 Monito nng� stern certification has <br /> been cojrupjctLdv►�ithim past 12 months. <br /> 10 SecondarY containment tests have been ca feted within <br /> the aired timeframe. <br /> I I Spill containment structure(bucket)testing was cow jeted within the St ear. <br /> I2 Tank fightuess—festing was completed within.required timeframe, <br /> 13 Lme qEPP=testing lva-�m—Ieted YA' required timeframe. 7: <br /> 14 Other I aired testier maintenance was corn leted within r <br /> timeframe. (List Yes,-�qjaint�n=ce items below.) <br /> FACILITY EAVLOyEE TRAINING Y N NA <br /> 15 All facility ern Joyees,have received the re njr—jan-thedab 1rnj-ninffnr <br /> 16 All facility em loyces hired within.the ast 30 days have received the required on-thejob trahaizig. <br /> Note: Any answer of"N"sbould be exPlained in the comment section On the fallowing Page,and will require <br /> follow-up action. <br /> Shirley Environmental Testing,Corporation <br /> 9595 Lucas Ranch Road,Suite#100,Rancho Cucamonga,CA 91730 <br /> 800-533-4030 <br />