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MRY-08-2006 15:54 TIME OIL CO. 2062864477 P.08 <br /> 0 • <br /> Designated Underground Storage Tank(UST) Operator <br /> Monthly Visual Inspection Checklist <br /> Facility Name:Time Oil - - Date: / <br /> Facility 6 G J <br /> Ci Zip Code: A/37-1 <br /> DesignFatdMMOmatorConducting nspeon:Dennis Tweedy I <br /> Interna' e Cotufcit Certificatio 44489-UC Expiration Date: 10/14 106 <br /> S' Phone: 425 )210 7998 <br /> Y-Y N=N NA—NotA ' abl <br /> ITe <br /> Item MONITORING PANEL/ALARM HISTORY Y N NA <br /> 1 Monitoring s stem is powered on and in aTer operating mode. <br /> 2 Monitoring system is not currently showing any alarms or warnings. <br /> 3 Alarm history repoWlog for the previous month is available,and has been reviewed by the <br /> Designated UST Operator. Attach a copy of the alarm history repor0og to this orm . available <br /> 4 Each alarm for the previous month has been responded to appropriately. <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 past month•_ <br /> Note:$corps where an alarm has occurred in the past month moat be inspected unless a qualified service technician respondedta and <br /> properly adamssed,the cm'se of the alarm.Attach documewatim verifying appropriate service to'his report. <br /> non is ragwreit record results in item 6,below. <br /> UST SYSTEM INSPECTION <br /> 6 Tank-top containment sumps are free of water,debris,and hazardous substance. Sensors are located property. <br /> Nate:Viral fns 'fon ora.fs an&required in sum s where an alarm has occurvd in thapast month or which there is no semim rernrd. <br /> Y I N 1 I N <br /> Sump Locallon: Sump Location: <br /> SUMP Location: JY7 I Sump Location: <br /> Sump Location: Sum Location: <br /> 7 S iR containment stractures are free of whtet,debris,and hazardous substance. <br /> Y I N NA Y N NA <br /> Tank 1-Contents: Tank 3-Contents: 41 <br /> Tank 2-Contents: l^ ' Tank 4-Contents_ <br /> 8 Underd' user containment areas are free of water,debris,and hazardous substance. Sensors are located 1 . <br /> Y N NA Y N NA <br /> Dia eraser 1/d Dispenser 9110 <br /> Dispenser 3/4 Dispenser 11/12 <br /> Drs eraser 5/6 Di poser 13/14 <br /> Dispenser 7/8 Div user 15/16 <br /> PAPERWORK INSPECTION Y N NA DATE DONE <br /> 9Monitorin m certification has been Com )pled within 12 months. = /Z^S <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. <br /> 12 Tank tightness WstiM was completed within required timeframe. u <br /> 13 Line ti tress testing was completed within required timeframe. 5T <br /> 14 Other required testis maintenance was completed within required ' eframe. ist to maintenance items below. <br /> Test/Maintetance: <br /> TestlMaintenance: <br /> TestlAvaintenance: <br /> FACILITY EMPLOYEE TRAINING Y N NA <br /> 15 All facility employees have received the required on-tbc-'ob training within the est ear. Irl 1 <br /> 161 All facility em to ees hired within the ast 30 days have received therequired on-the-job train <br /> Nott: Any answer of"N"should be explained in the comment section on the following page,and will require <br /> follow-up action. <br /> Page I oft November 2004 <br />