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07/24/ZQ08 W55 FAX IfoQl <br /> Mouth uspectioll - Page L of I <br /> -171 f <br /> I-=71 11—Y <br /> PAPURWoRK INSPECTION Y N NA Date Donc <br /> Mi.init0filig sv.-zteni cerLilication (widain Pasi 12 manLhs) <br /> ,3ALI 1441�,kt;tir,5tingEqmp-li-ete—du (within 12 rw 11115) <br /> xlronc far Tno nwIh5L-r t.,,o rt , 6+ <br /> i Sitcs(within past 17, <br /> 7w above um eaw Av deux logOlfc,(.,cl,-.&ttnuui havifiq.I(xvi regiflaeor, _4— <br /> Line TwAHC.SS(Usually tjpkrn UjIlls wl <br /> I,-UCjjnn<Pr when mi.rmsitm ShWO <br /> fion or wileml ming SM) <br /> (usually(Inly jjjjv.r con%fruc <br /> containment SB989)te'$L'4have bcciicoat 2feted (,,MLPIIYUVUl'y3 MI V< (0 074- <br /> re-17F CLY qWU I them N 4. <br /> Te x L'. -Ant LXIMICC: <br /> Comr. -;it%*. <br /> ',e runt Follow-up ACtions: <br /> Monthly inspection JnLLst be conducted by un ICC licensed Designated (Verator. <br /> A copy of this checklist mwst be provided to UST owner or operator, but not to State Walcr Rmourms. <br /> Designated Operator must alert the UST owner or operator of any condition disuovered during the <br /> monthly inspection that may require rtillow-vi)actiOft- <br /> UST owner or o.pcmtor Must maintain a copy of N4 monthly inspection and any btuchmeriL for the <br /> previous 12 months. Records must be majntainRud on-site or,if approved by the Imal agclicy,off-,-,Ite at, <br /> I - <br /> HrUdilyavailable location. <br />