Laserfiche WebLink
UNDERGROUND STORAGE TANK SYSTEM <br /> DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> rev Q� <br /> Facility Address: Z7 G✓ Gft�vr e lr/gy City: <br /> S>x�io� <br /> Name of i)esignated l IST Operator Conducting Inspection: 1./,e,7ryX .Z?-W. <br /> _,__.._.____ �. Ex irationDate: <br /> International(Aide Council f unification No.: S Zt�G _____ p <br /> Signatures _y.---- �- Phone: (c } �e�/0V ext. <br /> T" WA=Not Apoicatilla <br /> Iter MONITORING PANEL/ALARM HISTORY Yes No N!A <br /> I. is the monitoring system powered on and in Era 'r operating made? _ <br /> g= <br /> 2 Is the monitorin s stem not currently showing any leak alarms? <br /> 3 Is the .Alarm History Report/log lir(he previous month available.,and has it been reviewed by the. <br /> _ <br /> Designated UST WOO (Attach a ca ly of the al nnn history re/wftAog 10 this inspection form.) <br /> 4__ Has each alai to for the previous month been responded to a ialc) ? <br /> _ tlSl•SYSTEM INSPECTION ^ <br /> $. Are tank-top containment sumps free of water,debris,and hazardous substance'? Nolo:ji-dw art.' e, lr�hen,4 cat "7.•...".,4, <br /> ar hem 6 Sumps Mare an alarm lots mrurred m/hr past" mlh muel be ti+sperfed if a yualifwd.urvira+p'hniriarr ha: mH r.-.tpmrhd+°.urui <br /> n. dti rvktrr.+.sed.+(r maser +hr afnrm.lNu'u+xr•nlnri.m rrrl juin a rr uia+r.vrvi'e sJowhf be uruulari ra Al"tn >rt <br /> Yes No - <br /> -- <br /> sum—'a Sum Location: <br /> Sum Location Sum I.tx•ation: <br /> 6. Are spit(buckets(containment xtructure_s)tree of water,debris,and hazardous substance? <br /> Yes No NIA <br /> Yes No N/A <br /> Tank I ID-- —~---� Tank 4 ID- - <br /> Tank 2 ID- _ Tank 5 ID- ❑- <br /> Tank 3 ID- tank 0 ID- <br /> 7. Are underudispzos r containment areas flee of water,debris,and hazardous substance? Yes No N/A <br /> WNoN/A <br /> Dis a nser- 1/2 Disser-Dis nser-314 Dis n11!12 <br /> Dis nser-516 Di; nser- 13114 <br /> llis asst-718 --'TDis mer- 15/16 <br /> 8. leak detection is Properly located within under-dis nser containment. Yes N/.4 <br /> Yes No N/A <br /> Di, user- (/2'__--_- — Dis nser-9/l0 <br /> El <br /> Dis user-314 Dispenser- I(/12 I <br /> Dis ser -�5/6 Dispenser- 13/14 <br /> Dispenser- 718 Dispenser-15/16 <br /> PAPERWORK INSPECTION Y No N/A Date 0o <br /> i). Momtorin S�ystem Certification was mm Act within the ast 12 months? - <br /> 10. Line Leak Detectors were test certified within thLpast 12 months? <br /> 11. S ill bucket(containmentstructure)testin co leted within the past 12 months". <br /> 12. Lice tidiness testing cam_�+teted within the rNo fired time frame'' <br /> I'i _ _SeeonLaix_ontainment tests cont keted within the r uired time frame? <br /> 14. Enhanced Leak Detection cum Icted within the required time frame? <br /> 15 Other rei wired testin maintenance was cont Ictu1 within r aired dime frame? (U.rt rectineaintenareee nems helou•J <br /> Describe TestlMairaeewnce: T = 1 _ <br /> Desen he'Cest/Mamtenance: <br /> FACILITY EMPLOYEE TRAINING.__ __ Yes No N/A <br /> ib. Have all facility et>�loyees received the rct(uired on-the�ob traimn within the past year? <br /> (7. Have alI facilit em Io ces hired within the ast 30 days received the re aired on-the=ob travim .. <br /> Nate: Explain any"No"answers in the`Commentti'section on the fallowing page."f Those issues reyuirr,corrective action from <br /> the lit i .rwncriopet atoi 9r6gr' <br />