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Designated Underground Storage Tank(UST) gperlltor <br /> Monthly Visual frispection Checklist <br /> F " Name. I�_ <br /> Daft: - a� 06 <br /> Facil Address. o YaSe M4 — — LIPCode: ._ <br /> C - <br /> Des" ated US7'O Conductin the coon: 4 rtaion lhne /a/ 7 ! o_ <br /> hileme4oAid Code Council C on#: b So Phwe:(��r ) `tri. RQ <br /> 5 atln'e: ..y-y N+"N NA-NW APOOMe <br /> item <br /> lYIOIYIMY)]IING PANEL/ALARM MTOR1( Y N NA <br /> i Monitoring s is wared on and in operati%mode. _ <br /> 2 Moukol s Stets Is not Cnrrcnrl 'Twing my ularnts of wamin s. <br /> 3 Alarm history mpwvlog for the previous month is available,amt has ben'nrviewed by the <br /> Desi UST eraWr. Attach a c -thc alarm furor re orillog to this eum i avaUable v <br /> 4 i Each alarm Cot doe reviousmonth has been re d w a m tiatel _ _ <br /> 5 Sensors located in Wrnk•to contawrmnt sums have not aiamted in the pust month, <br /> - List aU tars*-lap$amps where alarms occwred in the past month: .._ <br /> Nok:. mps where an atm'w has___din dm Pant,A_*h rant ba dw gwcW wd..a yud4ieds'ror.•e Rwhdeimt Mtparded b,NM <br /> properly a(dwssed(ler caw$9(dw alt Almch drxaam'rttatimverhirySaPPrV"Ale rerrice'a*1 r*'Mf. <br /> LYIM 11 /W1.164'Wd I'CSdJ41w IJ8tM S.SCIOW, __..___ _..�_ _ <br /> OST SYSTIdM 1N6PECT70N <br /> 6 Tank top containment sumps are free of water,debris, sad hazardous substance. Sensors am located properly. <br /> Nur:Vlsud i Wn o', <br /> am n oohed lnat 41dart$hove aaerred ie the —.,*krwhdl$here is oro rvl Nre"d <br /> X N <br /> Sam Locar(on: Sum Locatitm: •„ <br /> Swnp Locatirm: Sunt Location <br /> Sun LcemYart: Sum Locatirt _�.. <br /> 7 Spill containmentshucttuaa are fee of wens$,debris amt hazardous sn x&we.4_ <br /> Y N NA Y I N I NA <br /> Tank 1 -Cantents: v Tank 3-Cat'erdar: Or� <br /> Tank 2-Caruents: Torok 4 Contents: <br /> 8 Under-din unser cordal v'r meas are free of water,debris,and hwzmrduus substam:e, Sensors are located r' ar <br /> Y N NA IY I N I NA <br /> Dir rover 1/2 4 Dh encs$ 9/10 <br /> Di mer 3/4 Dis nsav 77/12 _ .. <br /> D ease$S/6 <br /> Duqverwer 13 114 <br /> Dir emer 7/g Lila suss$15/16 <br /> PAPERWORK INSPECTION Y N I NA DAME DONE <br /> 9 <br /> Monitoring s alem certification has been c leted within 12 towtbs. <br /> 10 Secondary containment testa have been completed within the CWtri=dIrIck me- 42 - e 7 <br /> 11 S '1 contaittmait stnictsre bucket ben' was wen feted within the your. <br /> 12 Tank t tneLS teArn was completed within aired tituctitmte. _-,_„_. <br /> 13 bine ti trte96 testing was completcd within Tqulred timeframe. <br /> 14 Chher required te3tingimainleutat=was completed within required tiacfrdme. (Lill lesi/mairtten- Ueras heiaw. <br /> Tvst/Maoaenanae: _ - <br /> I est/Mawlemnce: <br /> "I'ett/Maimenanee: <br /> FACA.ITY g,1ypI,0YEE TRAINING Y N NA_ 15 P 11 facility emplo ees have rore=ved the requucd On-rhe-lob training within the past yearLf <br /> l6 All facil" em to =,;hired widrm the t 30 d s have received the uaed on-the=o <br /> Note: Any a'swcr of"N"should he explained in the comment section on the following paMv,and will require <br /> fallow-up-action. <br /> Naso 1 Cf2 Septernkr7.004 <br /> Sli8'd ££to£896802:01 :We 3 20:£0 9002-b0-100 <br />