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FEB. 21. 2006 8: 36AM G N0. 599 P. 3 <br /> Designated Underground Storage Tank (usroperator <br /> • Monthly Visual Inspection Checklist <br /> Rjgtemaafiozal <br /> o efti Date: O <br /> O <br /> c Code: yo <br /> 0 entor Conduc ' the action: i c o C__ <br /> e CoUnoil Certification IF. <br /> a 8 - C iration Date: i / / o <br /> Phone: 2e R <br /> Y=Yes.N-No,NA-NotAvvfimbJe <br /> Itetn•... MONITORING PANEL/ALARM MSTORY I Y I N NA <br /> r <br /> I M6nitorin s stem is o-e A ori and in ro er o e-atin mode. <br /> 2.. .Monitorka .s stem is not Curren show" an alarm- ------- s. <br /> 3 Alarm history report/log for the previous month is available,and has been reviewed by the <br /> Des' tad UST O erateir, (Attach a COUVo rhe alarm hist re ordlo to this orm ff available. <br /> 4 Each alarm for the revious mouth has been responded to appropriatelY. <br /> -S .Sensors loeat%I)AtanL'-WP containment sumps have not alarmed in the past month <br /> 5a List all rank,top sumps where alarms occwred in the past month: <br /> Note.'SSmyrs where an atarnt hrs oenamd rte rh¢pas!month rm�sr lx inspected unless a gua!(ttcd servte¢mchntctan responded to,mrd' <br /> prop¢rlyaddressed th¢awe ebee aZarm Arach dacrmunradon ver#,jyrng appropriate service to this repor[ <br /> sra ih4 Geon ism fired,record rervlts cx ifom 6, below. <br /> UST SYSTEM INSPECTION <br /> 6 Tauk-top containment sumps are free'ofwater,debris,and hazardous substance. Sensors are located*perly. 1 <br /> Nae:Perini tar cdon Ofmano is enty requiradih s where m alarm has=and in the Pao month rwhteh them k no service record <br /> Y N Y N J <br /> S Location: Surn Locdaron: <br /> Sum Location Location: <br /> Stan Location: Now Location: <br /> 7, S till contaimnent structures are free of water debris,and hazardous substance, <br /> Y N �NA Y N NA <br /> Tank 1-Coraenfs:U v as Tank 3-Conten#s: �"� o D <br /> -Tank 2-Contents,, i e S Tank 4-Contents: <br /> 8 . Under-dis enser containment areas Ate'f ee of-water debris,and hazardous substance. Sensors are located XroDerly. <br /> X N I NA IY N NA <br /> 1Ji ahser.l/2 u\ Q Di eraser 9/10 <br /> Di enser 314 .2 Ck Dispenser 11/12 <br /> Dispenser 516. i e Se Dispenser13114 <br /> Dis 2mpr 7/8 1 D' ensa 15/16 <br /> PAPERWORK)NSPECTION Y N NA I DATE DONE <br /> 9 Monitorin s Stem certification has been cow. feted within past 12 months. ✓ <br /> 10 SeCOn containment tests have been Completed within the r u red timeframe. <br /> 11 S ill containment structure udcet tes ' 2 was completed within the ase year. <br /> l2 Tankti' esstesthx was'com letle within requiredtimefratne. <br /> l3 Iriheti' esstestier wasw completed dtimeframe. <br /> 14 Other re ' ed testin maitrten ce was Com feted within re d timeframe. List test/maitrtenance trams below. <br /> Test/Maintenmxce: c. <br /> •:TestlMa:7tmrtance-- <br /> Test/Maintendnce: <br /> FACILITY EMPLOYEE TRAINING Y I N NA <br /> 15;: :;Au facili .em to ees'have received there uired on-the-'ob trainin within the ast ear. ✓ <br /> 16 All facili em loyees hired within the past 30 days leave received the required on-the-job traimin <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 oft November 2004 <br />