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JUL-12-2005 09:26 FROM:TRACY T' -K & AUTO' S L209E325307 T 1640138 P.13 <br /> Designated Undergrour.d Storage Tank(UST) Operator <br /> Monthly Visual Inspection Checklist <br /> . Facili Naspc: L - ��-�"^' Date: -T <br /> Facility AddreT-Q t�T7 <br /> city: C,A- I Zip Code: <br /> Designated UST Operator Cond cting the Inspection: JrLA, <br /> International C de cil Ce ati n N: 5 O (g'Z l.(G Ex iration Date: i / /o /O <br /> Signature: Phone: S q 112 <br /> Y-Ym N-Ne,NA a Not A lietbte <br /> Item MONITORING '?ANFL/ALARM HISTORY Y N INA <br /> 1 Monitoring system is powered on and in proper o reratir mode. <br /> 2 Monitorin s stem isnot currently showing any:.larms or warnings. <br /> 3 Alarm history report/log for the previous month i:available,and has been reviewed by the <br /> Designated UST Operator. Attach a copy of the.Harm histo report/logrepor0og to this form i available. <br /> 4 Each alarm for the previous month has been rep(nded to appropriately. <br /> 5 1 Sensors located in tank-top containment sumps h..ve no:alarmed in the past month. <br /> 5a - List all tank-top sumps where alarms occurr,d in t1 re past month: <br /> Nose:Sumps when an alarm has occurred in the part m mth mu a be/aspected unless a quaViiedn vice technician responded to,and <br /> properly addressed,the caueeof the alarm.Attach docu eematie n verifying appropriate service to this report <br /> I coon is Q=record results in item 6,i elm. <br /> UST SW TEM INSPECTION <br /> 6 Tank-top containment sumps are free of water,de iris,aid hazardous substance. Sensors are located properly. <br /> Nate: Ysnnl im etion of mmwx is onINYr ed invhere a s alarm has oa red in rhe month w which Acre is no service record <br /> Y N Y N <br /> Sum Location: Z�L- Sum Location: <br /> Sum Location: dvl t Sum Location: <br /> Sum Location: 12- Sum Location: <br /> 7 Spill containment structures are free of water,deb ris an I hazardous substance. _ <br /> -Y.. _..N RAI Y NA . <br /> Tank 1-Contents: Tank 3-Contents: <br /> Tank 2-Contents: Tank 4-Contents: <br /> 8 Under-dispenser containment areas are free of wan er debris,and hazardous substance. Sensors are located properly. <br /> Y N NA I YJ N I NA <br /> Dispenser 1/2 Dispenser 9/10 <br /> Dispenser 3/4 Dispenser 11/12 <br /> Dispenser 5/6 Dispenser 13 114 <br /> Dispenser 7/8 Dis enser 15/16 <br /> PAPERWORK IISPECITON Y N NA DATE DONE <br /> 9 - Monitoring system certification has been con let(d wit}in past 12 months. <br /> 10 Secondary containment tests have been completed withir the required timeframe. <br /> 11 Spill containment structure(bucket)testing was cc mplet,A within the past year. <br /> 12 Tank tightness testing was completed within requi ed tin eframe. <br /> 13 Line tightness testing was completed within requi ed tim:frame. <br /> 14 Other required testing/maintenance was completed within required timeframe. List test/maintenance items W04) <br /> TestlMaintenanee: _ <br /> Test/Maintenance: _ <br /> TesluUainlenance: <br /> FACILITY EMPIA)YEE TRAININGN NA <br /> IS 1All facility employees have received the required c n-the- ob training within the past year. <br /> 16 1 All facilitX employees hired within the ant 30 dal:have received the re uired M-the=ob training <br /> Note: Any answer of"Nn should be explained in the co.nmen t section on the following page,and will require <br /> follow-up action. <br /> P:ge 1 oft September 2004 <br />