Laserfiche WebLink
Q <br /> tLt <br /> r <br /> d <br /> CIL <br /> 0 Designated 40' r I kI IN eA )Operator <br /> m M ist <br /> N Facility Name. -� Gq'7--1 . alb e a` Hit <br /> p Facili Address: - <br /> cit}': - -.K- <br /> L <br /> DesismatedLIST O rator Conductin O ' <br /> International Code Council Ce a on <br /> 0 - - - - - - are: /6 / -) <br /> 3 Signature'. NII filo'f I-':ws WOk19r1L .� ) .-��,h. o D <br /> y eye. N.N.,,NA=NOIR rlka6le N <br /> Item >IO tY Y N NA Cl) <br /> 70 - <br /> to 1 Moniwring system a nw'Cred on k m <br /> (D '_ Monitoring system is not aurentl x < <br /> _ 3 .Alarm history reporolog for the p .ewed by the k <br /> O Designated UST Operator, (Arrack iu arm if available.) <br /> 4 Each alar for the previous month f` e rn <br /> O ? Sensors located in tank-to conta I -_,_,l 5 tooth. L <br /> _0 �.� <br /> 0 5a - List oi!tank-top nurrpc ulrcre <br /> M,,, l p- h I ! J rl / _r ( rb - ➢. red I cuqutljd .rc nchnirian rrsponakd/o.and <br /> /tl r /( br b/ r.oras to h ren➢yrnpnmc:coir.to/lr6 nyxrrl. <br /> /( m➢firsnmr p r.d 1 volts rn➢un 6.h<lox. <br /> W m <br /> fill <br /> N LIST Sit STEM INSPECTION <br /> 6 Tank-top containment sumps are free of water,debris,and hazardous substance. Sensors are located properly. <br /> I vat rr:ztr.,nofna", rruM.di..rvnn r.d+c cm.n1,,s hoc oecrnredm/he vn.mnhort rorr rcicr r,,d, <br /> Y N I I Y N <br /> M .Sully t Location: gun Lncatinrr: Z <br /> p .Sump Location: Cn <br /> .Som Location: <br /> .Sum r Locano'; I Stanp Localion <br /> Q 7 Spill containment structures are free of water,debris,and hazardous substance. <br /> O Y N I NA Y N NA m <br /> =3 Tank I -Cwolt, J Tank 3-Contents: m <br /> OI Tank 2-(,,went Tank 4-Contents <br /> : <br /> T 8 Under-disperser containment areas are free ofwater,debris,and hazardous substance. Sensors are located 71 <br /> O Y N NA Y 0) <br /> N Drew a-! �" <br /> X plc en.ver 9/10 <br /> 3. J XI—EDn rn.ser 1l/12 O <br /> N Dispenser5;6 x pis xnser(3/14 n <br /> N Dispenser 7/A } plc enser 15 13116 <br /> � r <br /> PAPERWORK INSPECTION Y' N NA DATE DONE O <br /> CD 9 Monitoring system certification has been completed within Past 12 months. > Z <br /> 40 <br /> Q <br /> 10 Secondary containment tests have been cont letrd scithin the required timeframe. <br /> I 1 Spill containment structure(bucket)iesturn was cont leted within the past year. <br /> 12 Tank rightness test in g was comp Ieled wish in ret aired timeframe D <br /> S 13 Line ti fitness testing was comp lei ed within req uired timeframe. <br /> O r' 14 Other required testin 'maintenance was completed within required timeframe- (1.i.cr rea/nrninrenwrq'e iremc helnwTiEEE./ <br /> Test/Flaimenarrce: <br /> N TevGMmrurnonce: <br /> N7e-cn:4fnhnenancc: <br /> �FACILITN EMPLOYEE TRAINING <br /> O N NA <br /> :3 IS All facility employees have received the required on-the-job tramutg within the as(year. >c <br /> 16 .All facility employees hired within the past 30 days Imve reccived the t uircd on-the-bb training. <br /> Note: Any answer of^N"should be explained in thq comment section an the folio"ing page,and will require <br /> N follow-up action. <br /> O <br /> V <br /> I <br />