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MRY-08-2006 15:55 IME OIL CO. 2062864477 • P.10 <br /> Designated Underground Storage Tank (UST) Operator <br /> Monthly Visual Inspection Checklist <br /> Facility Name:Time Oil L~ s Date: -/ <br /> Facili Addre Lt' <br /> C' : a� Zip Code: <br /> Des' ated UST Operator Conducting the Inspection:Dennis <br /> Intetnati Cil Ceruficatio Tweed 244489-UC E iration Date: 10 114 /06 <br /> Si Phone: 425 210-7998 <br /> Y=Yes N=N NA=NotA acable <br /> Item MONITORING PANEL/ALARM HISTORY Y I N NA <br /> 1 Monitoring system is poveered on and in proper operating mode. <br /> 2 Monitoring system is not currently showing any alarms or warnings- <br /> 3 <br /> amin s.3 Alarm history report/log for the previous month is available,and has been reviewed by the x <br /> Designated UST Operator. Attach a co o the alarm history nporillog to this form i 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:Sumps whom an alarm has occurred in the past month must be imspected unless a quaafied service tachniman miponded to,and <br /> Properly adhesed,due cause of the alarm.Attach docmaematlm wrifj tog appropriate service to this report. <br /> prstanip inemcdoot is niquitnid,mead remulu 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 properly. <br /> Note:Visual ins ration of same is only requited in sumps where an alarm has Detorted in the Lwymonrhj6r which them ism servi"record. <br /> Y N Y N <br /> Sum Location: Sump Location: <br /> AML N_ Sump Location: <br /> Sump Location. Sump Location: <br /> 7 Spill containment structures are free of water debris,and hazardous substance. <br /> Y I N NA Y N NA <br /> Tank 1-Contents., 1 Tank 3-Contents: <br /> Tank 2-Contents: Tank 4-Contents: <br /> 8 Under-dispenser containment areas are free of water,debris,and hazardous substance. Sensors are located 1 . <br /> Y N NA Y N NA <br /> Dispenser 1/2 Drs onset 9/10 <br /> Dispenser 3/4 Dis eraser 11/12 <br /> Drs enter 5/6 Dispenser 13 114 <br /> D' eraser 7/8 Pis enser 15116 <br /> PAPERWORK INSPECTION Y N NA DATE DONE <br /> 9 1 Monitoring system certification has been completed within past12 months. - <br /> 10 Secondary containment tests have been completed within the required timeframe. Ole <br /> 11 Spill containment structure(bucket)testing was completed within the past ear. <br /> 12 Tank tightness testing was completed within required timeframe. Lf <br /> 13 Line tightness testing was completed within required timeframe. Xt <br /> 14 Other required testis maintenance was completed within required timeframe. ist testJmaintenance items below. <br /> Test/Maintenance: 2 - <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> FACILITY EMPLOYEE TRAINING Y N NA <br /> 15 All facili em to ees have received therequired on-the-job training within the past year. <br /> 16 1 All facility employees hired within the past 30 days have received there uvred on-the-job training. <br /> Note: Any answer of"W should be explained in the comment section on the following page,and will require <br /> follow-up action. <br /> Page 1 of 2 November 2004 <br />