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Desiigilar0 Underground Storage Tank (U40 Operator <br /> 1=acilit Norrie: Monthly Visual Inspection Checklist <br /> Facilit 111 Address: )ate: <br /> fit . <br /> Zi Code: <br /> Valley Underground Tank Monitoring <br /> Mailing and Remittance Address: Valley Underground Tank Monitoring <br /> P.O. Box 91 <br /> L1esi noted UST OlDeratOr Conducting the Ins ection5tockton, CA 95201 <br /> - Ex iraaon Date7N _ 1 2008 <br /> Si nature: Phone: Z <br /> Y-Yes, tV=No, NA=Nut Applicable <br /> Iterrl Monitorin PaneU Alarm Histo <br /> M11 <br /> ng s stem rs powere onan In properoperali Y N NA <br /> ing system is not current y s Owln an a arms or warnings.Istary repo og or t e previous man Is oval A s n review <br /> by the Designated UST Operator_(Attach a copy o(the alarm hisarf'rri �f/P� rr availa4le). ,f <br /> iF Fa-e))a arm fort o prevroas mo nt as an respon lo ap roprrafe y. <br /> 5 ensors oca a in tan -top contammen sumps ave no a a In a pas mon <br /> a List a —tank-top sumps where alarms occurre to a past mon .f <br /> /10 <br /> /vola: Sumps where an alan-ft has Occurred in rho past month must be m spaded unless a qualified service <br /> recl)niGirdrr IUspcxided la, and properly addressed,the cruse of W alarm. Attach documentation veritykig <br /> appropriale service to /his report_ if sump inspection is required,reran}results in item ti, below. <br /> UST S stem Ins action <br /> n -tap canto+nment sumps are tee o water, ns,an r airs sir lance. <br /> Sensors are lacateri properly. Note:visual inspection of sumps ere rangy required <br /> i n aa..:,ps wl+tlr� an r,larrn teas o�.currg+d Y'i tt18 past mon[h for which[here is no service recaari7 <br /> um,p ocatlr,n: ump oeation: - <br /> aIn ocatlon: Sump Locatran: <br /> urnp ocatioul: um ocal&on: <br /> til craniainment structures are re®o water, a ns,a zar ous su stance_ <br /> an Conte nts: an ontents: <br /> Tan ontents: <br /> an 4- ontents: <br /> n er- <br /> dispenser containment areas are tee o water, ens,an azar ous su stance. ensors <br /> are located eroperly. <br /> Dispenser 1/2 Dis'11— user <br /> 1spensEr ispenser <br /> ispenser bibIs nser <br /> is ansa/ �-- Ispenser '� <br /> Paperwork Inspection Y N NA <br /> onilwa system certi Icatlon as een compete wIt In past moat s. ✓ <br /> ecran a containme�testsave en cam et wI ��f�eq time tame.P� containment strutesting was comp et past year. <br /> an lig iness testing was completed within require tlnleramas. <br /> line tightness testing was completed within re 9uired tlnne rame. <br /> 74- er requitecl lestingimaintenance was comPelea within require me came. (List main(. items below}. <br /> es inalntenanee: <br /> es maintenance: <br /> es Uniainlenance: <br /> Facility Em to ee TrainingY N NA <br /> 1 sac+qty employees ave receive t e require on-t o training Int the past year. <br /> as qty employees hired within Me pastdays have received the require <br /> on-Ihe-nb t.-wining. <br /> Note: Any answer of "N" should be explained in the comment section on the following page, <br /> and will require follow--up action. <br /> Pg. 7'pf 2 <br />