Laserfiche WebLink
Designated Underground Storage Tank (UST) Operator <br /> Monthly Visual Inspection Checklist <br /> Date: j_Z, ,r - <br /> `-- Faciiity Address: <br /> City+ r1!? a`r Zip Code: - <br /> Valley Underground lank Monitoring <br /> lWailing and Remittance Address: Valley Underground Tank Monitoring <br /> P.O. Box 91 <br /> Stockton, CA 95201 <br /> Designated US]- operator Conducting the Inspection: J) art�, J,r.l r <br /> ICC Certifi a XX Ex iration Date: 0 ,,,p <br /> Sir nature: j ! A Phone: 2c)9-649-89.56 <br /> Y=Yes, N=No, NA=plot Apphtr able <br /> !tern .T [Monitoring Panel!Alarm History Y N NA <br /> 1AAotiilorincl system is powered on a the in proper operating. , <br /> oniloring:system is not currently snowing any alarms or warnings. <br /> Grin history repoWlog for the previous mon!h is avai a e,an as een reviewed <br /> by the Designated UST Operator. (Attach a copy of the alarm history repo(Viog if available). .� <br /> 4 ac i a arm o.t e previous month as been responded to appropriate y- , <br /> 5 ensors oca a rn tan -top containmen sumps ave not alarmed in the past month. <br /> - aList all tank-top sumps where alarms occurred int the past mont <br /> tvotu: Sumps where an aiarrfr Pas occurred in the past month must be inspected unless s qualified service <br /> tGchrriciarr lospontleri 1cr1 and properly addressed, the cause of Iho alarm. Attach documentation verifying <br /> atrpropneie service to#tris report. if surrip.inspection is required,record resims in item 6, below. <br /> USTSystem stem !ns ection. <br /> n -top containment sumps are tree of water,debris,and hazardous'subFit'a.Ince. <br /> ensors are located properly. Note:Visual mspedion of sumps are only required <br /> r,)sr..—ps vvirere an alarm has occurred in the past month for which there is rio service record <br /> ump ocatton- ump ocation: �. <br /> �,pj <br /> ocatron_ ump ocatton_ — <br /> ocatron: ump ocatron: <br /> ontainment structures are ree o water, a ns,an azar ous su stance. <br /> an ontents, an - ontents: <br /> _ <br /> Tan - ontents; an 4 ontents: <br /> Onjer-dispenser containment areas are tree a water,debris, and hazardous sul5stance. ensors <br /> Wtsptnse(r <br /> ct roperiy. <br /> T N ' n <br /> rspenser 9110 1 rspenser .is enser 4 <br /> Dispenser 15/16 <br /> Paperwork Inspection Y N NA <br /> gV—system cerci rcatton as een comp ete wit to pas! mon# s <br /> L)niloring <br /> con a containment tests ave een compete wit in require timerame.u containment structure uc et testing was completed within past year_ <br /> an ttg tness jeslIng was completed within required time fames. <br /> Line tightness testing was completed within require time came <br /> other require es ung main mance was completed within required timelfame. (List main(. hams below). <br /> ast maintenance: <br /> est7mairitenance: <br /> es niaintenance: <br /> Facility Em to ee Training / Y N NA <br /> Il�aci[rly erne oyees ave receive the require on-t a-la training in t e past year. <br /> _'_ac, employees emp oyees ire wit rn the past days have receive the require w <br /> on-rhe- <br /> It training. <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. for 2 <br />