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Dt4nated Ilntlt W ,tnd gto�e -jUST) Operawr <br /> MQnthlYrl1-A"UWW-IAsPest• ecklist <br /> Faeilit ,Ntmte':<.L��'.,;£ c'' ?F,!a' ✓ <br /> �aatbaa' iY'fat•.�'. {..�',n. i.' e <br /> .Ut Code:'%JZ`I <br /> aatedUST t»tduesing the4twitwo6w, <br /> DU!VXR Cetifiwtiea#; .•i... tionOata: - /:,. <br /> Item M.QN CT / QgY Y I N J NA . <br /> .. -"l Monitortn sstemis ownedonmttlin ::. ..er eretin...mvde .:. �. ,, •... ... .. :. ,-.. a •• <br /> 2 AAwtirorin <br /> 3 Alarm i a wy repartltog fore previousnd ismileble,andi been mviewedby the <br /> d.LISS a ro-rMs naadable. <br /> 4 Each alarm for t o reviow tnaadhllas:*ow aspmdcd to i . <br /> S Sensors located inlaak• tttonth. <br /> -58 List all tank-!op sumps aatereAddrear eorwmed in the parr <br /> No/e: <br /> prosupmel lyiiwaW>rdenuw/••haiasttnrdei,tmrrheeacidrwtr'rarr6<afrthe alar on.Attach,akin morovn//r7"v-t!7 flut, Cu"i"10lthis <br /> rd recordends nebow. go »plrrcetsmdrr�Yl. <br /> � <br /> u.::.•. ..::... .. : . .•.;. :... .. .._.,.....•. <br /> ST USM M INS N... _ <br /> 6 ank-top containment sump,&AM fix of/uatt:r,debris,.artd subWnce. ,Copeors ire clouted properly. <br /> Nate:Viol ins mcaon a rum n ix vnly motored In sunt r^herr an alarm has t used lrt the m't mot//h m•w'hic'h there c,no aenrim word' <br /> YtINY N; Sum L orlon:Sum - <br /> S Cattalos: <br /> Sump L orison: a <br /> I 4coata tmtettt tnreturestrre flee ofvvater,debt s,ant!bazardou Gb➢tancc. <br /> _ N: . NA I Y; N I NA <br /> I'ettk!-.Gilelelelx: •': Tank T ."mems: <br /> Tank 2-Confaner.• .'ir - Tank 4- onrenrr: t <br /> X. llsssiler4wpasimreottWituuentacearare'}jam-ofwater..debria-omd rdtmssriubrtancr _s..chsc.tcd,,,,,.fl <br /> Y N -WA Y N . ,NA <br /> Dir user•1/1 . ic�Ig <br /> Dispenser 3/4 11.1-12 <br /> Ota enser 5/6 I_i114 <br /> Dix enser7/8 Dl .I5C14 <br /> i TtKPtRa'O1tK11YSYELTtoN. Y Tr _NA DA-MI)UNE <br /> V <br /> KmitCMPHIR system cerrifica+ion basbeen completed within post 14 onths. Y <br /> 4Q, t*estsimcbce,, trd-within-thcr i imeframe. <br /> ii ioamaitiment structure shyokct)4e%linst was tom Med within t sot ear. <br /> r 12 Tank noes - was eteC[W;hinsc <br /> 13 Une sa testi was led within 'ted timeframe. , <br /> 0 14 Other required les ' nta;ntca=c,.wyy wL4hixoqwreid ttime: Ldtr fesilnmhfmissm ne"'s brium.1 <br /> Test/Matmenunce: <br /> Test/Mas"remancer <br /> TEllMalnrertance: <br /> -FACi�iTi'tri►trtHYEE <br /> 15 All faeilit .em o ecsbave.mcivedther uiredon-the•' btraiiiin uhinthe ast car. <br /> 16 an eeahiwdwithin.;h¢ aA lteveraceiwedtfi irednr"hc-' treim <br /> Nolo: Any anower of etohowing page,and TM tegoim <br /> follow-up action. <br /> Pie i orz- September_004 <br /> S0 'd WU r0= h0 600L—£0—d3s <br />