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JUL-12-2005 09:24 FROM:TRRCY Tr -K & AUTO S L209E325307 T' 4640138 P•9 <br /> J <br /> Designated Undergrour d Storage Tank(UST) Operator <br /> Monthly Visual hlspection Checklist <br /> Facility Name: - Date: <br /> Facility Address: t C- <br /> City: CA Zip Code: q5 3 O <br /> Desi ate'UST O ator C ductingnthe Inspection: <br /> lnternational de uracil ggrtification#:5 4 b?'L(C_ 1 Expiration Date: 14/77/ <br /> Signature: Phone: <br /> Y-Yes N-N% e<NatApplicable <br /> ZD <br /> MONITORING P�L/ALARM HISTORY Y N NA <br /> nitoring system is powered on and in proper o jEgl tg mode. <br /> Monitoring stem is not currentlyShowingan ,darns or warnings. <br /> rm history report/log for the previous month i s available,and has been reviewed by the <br /> Designated UST gator. Attach a co o the Harm history report/log to this form if available. <br /> h alarm for the previous month has been resp(nded o appropriately. <br /> sors located in tank-to containment sumps h rve not alarmed in the past month. <br /> List all tank-top sumps where alarms occurs,d in tae past month: <br /> Note:swnps where an alarm has ocewred in the past n onth onsi be hopecied ,dw a qual�ednmice technician reTa ded to,and <br /> properly addr—d,the wase oldw alarm Attach docu nemanw vvt(ymg appropnote semne m dos report <br /> I ction Is reired record rendu in item 6,,clow. <br /> 1!� <br /> UST SY'TEM INSPECTION <br /> k-top containment sumps are free of water,debris,and hazardous substance. Sensors are located properly. <br /> Notes Virval ctian ofsvmkpws is mrevqBred w #here an alarm hat oavrred In d e nate month r which there a rw n"iu record <br /> Y I N Y N <br /> Sum Location: (r Sum Location: <br /> Sum Location. I f> Sump Location: <br /> Sump Location: 11 Sump Location: <br /> 7 Spill containment structures are free of water,del��riisss--a����n------d hazardous substance. <br /> nk 3 Y N NA 1 .� <br /> 'Tank 7 -Contents: Ta -Contents: <br /> Tank 2-Contents: I Tank 4-Contents: <br /> 8 Under-dispenser containment areas are free of wa er,de�)ris and hazardous substance. Sensors are located properly. <br /> Y,. NLNA I Y N NA <br /> Dispenser I/2 Dispenser 9/10 <br /> Dispenscr314 Dispenser 11112 <br /> Dispenser 5/6 Dispenser 13/14 <br /> Dispenser 718 Dispenser 15/16 <br /> ME aPAPERWORK INSPECTION Y �N NA DATE DONE <br /> 9 Monitoringsystem certification has been com let A withinpast 12 months. <br /> 10 Secondarycontainment tests have been completed within the required timeframe. <br /> 11 Spill containment structure bucket testis was et 2mpleted within the past year. <br /> 12 Tank tightness testis was completed within requi-ed timeframe. <br /> 13 Line tightness testis was completed within requit ed timeframe. <br /> 14 Other required testis maintenance was complete( withi i required timeframe. List test/maintenance itemsbelow.) <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> FACILITY EMPL•3YE73TRAINING I Y I N I N <br /> 15 All facilityemployees have received the required en-the•'ob trainingwithin the past year. <br /> 16 1 All facilily em to ees hired within the past 30 da s have received the re uired on-the=ob training. <br /> Note: Any answer of aN"should be explained in the comment section on the following page,and will require <br /> follow-up action. <br /> P ige 1 eft September 2004 <br />