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MAY-08-2006 15:56 TIME OIL CO. 2062864477 P.11 <br /> Designated Underground Storage Tank (UST) Operator <br /> Monthly Visual Inspection Checklist <br /> Facili Name:Time Oil Date: - <br /> Facili <br /> Ci : r� G Code: <br /> Desi ted UST erator Conductin the Inspection:Dennis Tweed <br /> In Certificatio # 44489-UC Expiration Date: 10/ 14 /06 <br /> S' Phone: 425210-7998 <br /> Y=Yes,N=No NA=Nnt IicaWe <br /> Item I MONITORING PANEL/ALARM HISTORY X N I NA <br /> I Monitoring stem is powered on and in proper operating mode. <br /> 2 Monitoring system is not currently sbowiRLany 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. Attach a copy of the alarm hisloty report/logreporVlog to this form i available. <br /> 4 Each alarm for the reA=month has been responded to appropriately. <br /> 5 Sensors located in tank-top,containment sums have not alarmed io the past month. <br /> 5a List all tank top sumps where alarms occurred in the past month: <br /> Nate:Sumps where an alarm has ocera•red in the past month must be inspected unless a quaked service technician responded to,and <br /> properly addressed the muse of the alarm.Anach documenlaaon verifying appmpriak servke to this report. <br /> ! su au• cries is required.record results in item 6,helaw. <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 ction o sum is onl req hired in sumps where an alarm has occurred in the post month or which there is no service record <br /> N I Y I N <br /> Sump Location: Sum Location: <br /> Sum Location: Sum Location.• <br /> Sum Location: Sum Location: <br /> 7 S ill containment struemres are free oI—,U.debris,and hazardous substance. <br /> Y N NA Y I NNA <br /> Tank I -Contents: Tank 3-Contents <br /> Tank 2-Contents' Tank 4-Contents: <br /> 8 Under-dispenser containment areas are a of water,debris and hazardous substance. Sensors are located properly. <br /> Y N NA Y N NA <br /> Dispenser 112 1 Dis enser 9110 <br /> Dis eraser 3/4 Dir eraser 11/12 <br /> Dispenser 5/6 Dispenser 13/14 <br /> Dispenser 7/8 Dispenser 15/16 <br /> PAPERWORK INSPECTION N NA DATE DONE <br /> 9 Monitoring system certification has been completed within past 12 months. <br /> 10 Secen containment tests have been com leted within the uired timeframe. - /- <br /> I I Spill containment structure(bucket)testing was com Icted within the ast ear. <br /> 12 Tank lightness testing was completed within required timeframe. <br /> 13 Line tightness testing was completed within required timeframe. <br /> 14 Other required testinghnaintenarmc was completed within required time e. List tesilmaintenance items below. <br /> Test/Maintenance: <br /> Test/Maudenartce: -12 <br /> Test/Maintenance: <br /> FACILITY EMPLOYEE TRAINING I Y N NA <br /> 15 All facility employees have received therequired on-the-job training within the past year. <br /> 16 All facility,employees hired within the past 30 days have received the required on-the-job trainin . <br /> Note: Any answer of"N"should be explained in the comment section on the following page,and will req ire <br /> follow-rap action. <br /> Page I of November 2004 <br />