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Designated Underground Storage Tank (!)IST) Operator <br /> Monthly Visual Inspection Checklist <br /> Facility Nan,e -, / .fr r ,< Date: <br /> l�- l ac;ilit Address: <br /> Cil Y, jZip Code: <br /> Valley Underground Tank Monitoring <br /> Ulailing and Remittance Address: Valley Underground Tank IVlonitoring <br /> P.O. Box 91 <br /> Stockton, CA 95201 <br /> Desi noted US-1- O erator Conductin the Inspection: r1 r Tr_ p1T <br /> ICC Certificate XX41,41012575Px iration Date: // r <br /> Sit n;jture: y Phone: 202-642-8956 <br /> Y=Yes, N=No, NA=Not Applicable <br /> !tern Wsioiy <br /> Monitorin Panel/Alarm Histo Y N NA <br /> 4 Mornirstem ��r <br /> ere on an +n proper operatin ma a oratystem urrent y s owing any alarms or warnings. <br /> am) repo the previous month is available.and has been reviewed <br /> by the Designated UST Operator-{Attach a copy of(tie alarm history report/log if available). w� <br /> 4the previous mont has been responded to appropriate y. �. <br /> 5Sensors oca e in tank-top containment sumps have nof alarmed in the pasi month. <br /> a U1st a tan -iota sumps w ere a aims occurre in t e past moat : �� �/ <br /> r x'37 <br /> NOW. Jumps where an alarm has a:curred in the past monih mus!be inspected unless a qualified service <br /> technician rusponded to, and properly addressed, the cause of the alarm. Attach documentation verifying <br /> &i,propritrle service to this report. If sump inspection is.reguued,record resells in item 6, below. <br /> UST System Inspection <br /> n -top containrnentsumps are ree o .water,debris,and hazardous substance. <br /> Sensors are located property. Note:visual inspection of sumps are only required <br /> i n jojv an aiarrti has occun>sd in rhe past month for which there is no service record <br /> ump ocation: ump Location-. <br /> Bunn ocat+on: ump Location: <br /> Sump Location. Sump <br /> Location:; <br /> Spill containment structures are ree o water, a ris,and halafditius su stance. <br /> jontents- <br /> c <br /> -- an ontents:�an <br /> ank? ntents. �-- an 4- ontents: <br /> npenser containment areas are tree o water, debris,an hazardous substance. ensors <br /> aie located properly. <br /> 1 W1 NA I <br /> EU"ispenser ispenser ispenser ITAY <br /> 7 spenserr I Dispenser <br /> 15116 <br /> Paperwork Inspection Y N NA <br /> andoring system cert! kation as een compete wit in past mont s- �' <br /> Sewn a containment tests Rave been completed within require time rame. .� <br /> --m -P111COntallignerif structure (buck-tT testing was comp'�eted within past year- <br /> T—af-Tj-jg-Ej-jj_e_Sstesting was completed within required time rames. <br /> ine t+g)tness testing was comp ate wit in requirea timeframe. <br /> Other require es ing main enance was completed within required Urnetrarne. (List rnaint- items below). . <br /> est maintenance: <br /> ester+ntenance: <br /> es niaintenance� <br /> Facility Employee T raining Y I Nj NA <br /> f\ )�aGi sty ernp oyees ave receive the require on-the-job training int e past year. t <br /> facility employees hired within t e past ays ave received the require <br /> on-the-job rfaining. <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- Tot 2 <br />