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FR0,Y (ED) AUG 30 2006 1�3/ST. I7,33/No, 6843597301 P 14 <br /> Designated Underground Storage Tank(UST) Operator <br /> Monthly Visual Inspection Checklist <br /> Faci4tyName: Date: r <br /> Pacili Address! 7 r a c' <br /> city; S b t 1 Z' Code: L <br /> D"ignatBdUSTO rator Canductin the Ins !omion: <br /> Internure: Code Council 'fication#; -, .:,� _ V !ration <br /> Sianatw'e: - ,9 Phone: 4�. ✓ 4! <br /> Item Y•Y N-Ne,N4.N„tA Ikebk <br /> MON rrORING PANEL/ALARM HISTORY N NA <br /> MMY <br /> 1 2donator ing SYatoltl I_ f Dowered un and in f�roaar oyet'atinY mMle <br /> 2 Momtorin s sWm is wt current] showin any alarms or warn' s. <br /> 3 Alarm history reporulog for the provious monrh is available,and h is been reviewed by the <br /> 17esi ated UST waton Arrach a ca v o'lire almra hLsrory re orrAo ro this orm!/"ave laG/a. <br /> 4 Y!ach alarm for the reVious month has been <br /> rese2nded to a ro tiara <br /> S Sensors located in MKI! conetdnnient sunyps have not alarmed in the pert rn tatb. <br /> Sa <br /> List w?tank-rop.svglps where alarms occ'unad in rho prirr month: <br /> Nora:Sumps whirs on alm•m hie oeouerad in the yyyt mow),muar be enspucred'wml a gwljlied se i"w1wielOn n+pnnQ.d ro,Dori <br /> prol+rrly adNeered eN<aw'u ej'de alalna dareh decumrruariar rc <br /> J n!1'+n6'o{•proprWle rsry/m ro this rayon. <br /> cion a wr<2 neuryir'a'Ylte is into e;blow. <br /> UST SYSTRM INSPECTION <br /> 6 rp containment sumps are free oCwater,debris,and hazardous substanx. Sanson ere located property, <br /> tnyluer rro esrion a ram Is uni wred is e y whsrY rN alarm hay oe wNa fn r r mo,ah br which there u rro se"in rewrd <br /> Y N N <br /> Y <br /> Sum Lavation: Sam Locadon: <br /> Sum Lacarlon. Stare Lararion; <br /> S'�u Location: SYrME'EDeaton: <br /> 7 6 1 containment structures are free of water debr,s•and hazazdaus substance, <br /> Y N NAN INA <br /> Y <br /> Tank 1-Comrents: Tank 3-Contenrs� <br /> Task 2-Contents: Tank 4-Contents: <br /> 8 1lnder die er conraittmeat area aro free of water debH and hawdous subaunca. Sauon am located V l . <br /> Y N NA N NA <br /> Y <br /> D' reser 1/2 Df user 9/1 <br /> Die nsar 3/4 <br /> DUrianter 77 12 <br /> D' eraser S/ Dts ruerf3/!4 <br /> war <br /> D' rarer 15/16 <br /> PAPERWORK INSPECTION N NA DATE DONE <br /> Y <br /> 9 M utitorio s stem cardficatien has been eom leted wtdtip ast 12 manths, y Y , <br /> 10 bacon cotttalnment[acts have beep com lemd wtthintlte uired timeframe, /7 0 <br /> 11 Sill containment structure bucket testln was corn leted wldtht the ast ear, a <br /> 1I Tank ti ss testis was ca leted within r wired onieframe. V a -Ave <br /> 13 Line t mess tea ' was cpm leted w(thin aired timeframe. <br /> 14 Other uired res /maintenance was completed widtin re wired tlmeffame. Ut resdmairrrenance Items below,^ <br /> Tesr/Mainrenance <br /> TesdMainrerrance; <br /> Page 1 of 2 November 2004 <br /> Z0 3E)Vd CIdIOtid h3-1-lvn SSL080660Z 9£:91 9@0Z/6Z/80 <br />