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Designated-dnderground Storage Tank (UST)'6perator _ <br /> Monthly Visual Inspection Checklist <br /> Facility Name: tiA Date: y f , <br /> Facili[ Address: <br /> Ci Zip Code: <br /> Designated UST O erator Condns ectio,n: - AA,; <br /> International Code Council Certfi # / `Z ' <br /> I Expiration <br /> Signature: L i/ JIAA c,4, 44A • I Phone: 0 <br /> Y=Yes,N=No,NA=NotA plicable <br /> NG <br /> Item <br /> MON ITORIPANEL /ALARM HISTORY Y N NA <br /> 1 Monitoring system is powered on and in proper o2erating mode. <br /> 2 Monitoring system is not currently showing anv alarms or warnings. <br /> 3 Alarm history report/log for the previous month is available,and has been reviewed by the <br /> DesignaledUST Operator. Attach a co v of the alarm history report1loe report/loto this form ifavailable. <br /> 4 Each alarm for the previous month has been responded to appropriately. <br /> ,r <br /> 5 Sensors located in tank-top containment sumps have not alarmed in the a_st.monthr—­____- <br /> Sa _ List all tank-top sumps where alarms occui red the-pas—f-month: <br /> Nae:Sumps inhere an alarm.Inas ticcun-ed in the past nrmnh must be inspected unless a qualified service technician responded to,and <br /> properly add,e,sed,the cause of the alar-.. a <br /> Attach danneniation verifying appropriate sen ice to this report. <br /> ii'sunrp inspection is r equired record I cwlts in flenr 6.below. <br /> - �a+ti *nrHtixc.-vxm'nu=aavm ,<GecaHtwksu:.:... <br /> UST SYSTEM INSPECTION <br /> 6 Tank-top containment sumps are free of water,debris,and hazardous substance. Sensors are located properly. <br /> Note: Disual u spec'tion of sumps is onto re d in srnnps where an alai-in has occurred in the past month for which there is no service.record. <br /> Y N Y <br /> Suns r <br /> Location.' -^'"" Sum Location: <br /> Sum Lo atfdir. ": Sum Location: <br /> .._Suri Location: So <br /> �;.; Sump Location`' <br /> 7 S ill containment structures are free of water,debris,and hazardous substance. <br /> Y N NA Y N NA <br /> Tank 1 —Contents: 0? ./ Tank 3— Contents: „r' <br /> Tank 2'—Contents: / Tank 4—Contents: <br /> b Under-dis enser containment areas are free of water,debris,and hazardous substance. Sensors are located. ro p erl <br /> Y N NA I Y N NA <br /> Dis enser 112 _ Dis enser 9/10 <br /> p <br /> Dis enser 3/4 �• Dis>"'ser 11112 <br /> Dis enser 5/6 Dis enser.l3/14 <br /> Dis,enser7/Y Dis elise'r15/76 <br /> PAPERWORK INSPECTION Y N NA DATE DONE <br /> 9 Monitorin s stem certification has been completed within past.12 months. <br /> 10 Secondary containment tests have been completed within the required timeframe. Cy <br /> 11 Spill containment structure(bucket)testing was completed within the p past year. <br /> 12 Tanktightness testing was completed within required timeframe. . ,✓ <br /> 13 Line tightness testing was completed within required timeframe. <br /> 14 Other required testing/maintenance was completed within required timeframe. (List test/maintenance items below.) <br /> TestlMaiinenance.- <br /> Test/Maintenance: A,.r <br /> Test/Maintenance: ,- <br /> R .nf"MtMC.-R!'i We Sm .:h.^'.'. -0. �ixra?w<ai *bS VN«::eulkhV, i 3 �N.:'aSi Y.' •i Ld wZye,ShFs.'i..♦•'qY. b J 'Myx!ctta4„Y. , tF...1. If..n+.-.Y4Px�.4;<'nY4YNtio+af <br /> FACILITY EMPLOYEE TRAINING Y N NA <br /> 15 All facility employees have received the required on-the-job trainingwithin the past year. <br /> 16 All facility em lov ees hired within the past 30 days have received the required on-the-'ob trainin <br /> Note: Any answer of"N” should be explained in the comment section on the following page, and will require <br /> follow-up action. <br /> Page 1 of 2 September 2004 <br />