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Designated Underground Storage Tank(UST) Operator <br /> Monthly Visual Inspection Checklist <br /> Facil' Name: s_ Date: 1 -1?- 06 <br /> Fac7ityAddress: 707 MaxCode: <br /> w!.'f <br /> Uesl Awl UST Coadu the 1!=#a: ► r i! <br /> iatenntional C ouncil C #: So2.Siratian Date: r a;17 I off- ------. <br /> Y-Yes,N-M4 NA�NW <br /> llnm <br /> MONPlORING IaANG�L/ALARM HISTORY _ Y N NA <br /> 1 Monhori system is Bred on soba is r o aria made. _ <br /> 2 Monitor' s stem is aM curnntl showin an alarttw or waroiu <br /> 3 AIwtn history reporVlog for the previous umnlh is available,and has been nvwwed bby the . <br /> Oninated UST Operator. (Attach a copy gfthe alarm history repordlog to Max 6=i/avail�_.- ✓ <br /> 4 alarm for the pon <br /> victrs month has been resded to epproprwtab- <br /> 5 Sensors located iu teak caa1AinlnnW sumps have not alarmed itl the PaBt month. .. <br /> 5a List all tank-tw stoops where alarms occvered in the past month: ,� ....._ <br /> NMr:.9rwYa whim an alarm lYn ac;rrrrod to sae yet mweh rrwtt de huperfeJuaAae a yratr111edservairx recireterar mvparkJBA raid <br /> P+ap.*addrc &thr mm fthe ak m.Ann*dacwnerrrati—wrfyNS'approtwidr ar'"W draw mpe " <br /> tra-Pi a:frw b ,Ne mewd rendtr b Item 6,behrw. <br /> Ut!1'SYSTEM INSPECTION <br /> y6 Task top eoalaitrment satraps are lime of water,debris,and hazv'dous substance. sensors are locuted pNPeC1y. <br /> Ntee.- riaw m Chan a au fa Tisa la.sent where an alarm has arx:„rrad in rhv mr monilr - which rlxrr is ea�rWa v¢aonf. <br /> Y N <br /> Sum Location: Sum .Location: -_ <br /> Sum Location: _ Sumn Location: <br /> Sum Location: SUMP Location: <br /> 7 5 111 cmpaiamem'sttucdms and$oc of watex debris,and hazardous substance. Y N NA <br /> Y N NA _ <br /> Task t—Cnmenb: iPe a Tank 3-(n dears: Q; _ — <br /> ra hk 2-CoraeAo. / Pre L- Tank 4-Conteeb: <br /> 8 Undm-dispenser cents nmcot areas are hw of wase debris,soba hazardous subxtsaee. &r3oxa are loGded aper - <br /> X N NA Y N NA <br /> D ser I/Z Dia ewer —_.- <br /> Dir rarer 3/4 {- Di.... It/13 <br /> D!s or 5/6 .-..� a-� Dos eraser 13/14 <br /> Dispenser-718— Dis enser1S/16 <br /> PAPERWORK INSP6CTION Y N NA I DAT6DON6 <br /> 9Monitoring By <br /> a-tem certification huo been con Mated within ast 12 tmnths. <br /> ]0Secondary containment tests have been coreplated within the aired timefrmao- /O—o <br /> V15 �A �s <br /> ntainment stnwture ket tests was con eted within the past <br /> lightness a:onsaple[od whin haired timeframe. - - <br /> mess tests was con leoed within uired tunetiante. T <br /> irecitestis maintenance was con feted within required t6n Game. (List h yt/maitdura+acr items below. <br /> stlHfaintenance: _ -dMmntenanc-e: <br /> seMon"Ieratnce:_ FACILITY F.MPLOYEE TRAINING Y N NA <br /> l em to res have received the required on-the-job tr'aialnlS within the past year.it em to res hired within the 30 days have received the to uueJ on-the- b wwxn . <br /> Note: Any answer of"N"should be explained in ire comment section on the rullowiny,page,and will requite <br /> follow-ap action_ <br /> page I of t Suptember 2004 <br /> ST�9-d ££b£89t,602:01 caoa-� ti0:£0 9002-b0-100 <br />