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Monthly Ins ection - Page 2 of 2 <br /> PAPERWORK INSPECTION Y N NA Date Done <br /> Monite,trig system certification within past 12 months w <br /> S ill Bucket testin com leted within 12ast 12 months 1 y 7 <br /> Leak Detector-mQchanical/elrftrOnic for mQ51 5ites (within past 12 months) <br /> The above are usually done together on an annual basis for local regulator. <br /> Line Ti htness usuall u on construction or when no ositive shutdown <br /> Tank Tightness (usually only after construction or when using SIR) <br /> Secondary containment (SB989) tests have been completed (usually every 3 yrs X I Z J y <br /> Other testing or maintenance completed as required. List thembelow: <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> Comments: S)PG .j,1 L 10° Tul • 1 <br /> Items Requiring Follow-up Actions: <br /> Monthly inspection must be conducted by an ICC licensed Designated Operator. <br /> A copy of this checklist must be provided to UST owner or operator,but not to State Water Resources. <br /> Designated Operator must alert the UST owner or operator of any condition discovered during the <br /> monthly inspectior-`hat may require follow-up action. <br /> UST owner or operator must maintain a copy of this monthly inspection and any attachments for the <br /> previous 12 months. Records must be maintained on-site or, if approved by the local agency, off-site at <br /> a readily available location. <br /> m <br />