Laserfiche WebLink
Designated Underground Storage Tank(UST) Operator <br /> Monthly Visual Inspection Checklist <br /> Facili Name: r Date: <br /> Pacili Address; o og� t <br /> City: Zi Code: _. <br /> Desi nattd UST rotor Conductin the Ins ction: r' <br /> International Calc Cou it Certification N: Ex iration <br /> Signature: Phone: <br /> Y-Yes N.No NA Not Applicable <br /> Item MONITORING PANEL I ALARM HISTORY Y N NA <br /> zM <br /> 1 Monitorin s stem is werod on and in m o eratit mode. <br /> 2 Monitorin s stem is not cufrentl showin 8n alarms or waroin s. <br /> 3 Alarm history report/log for the previous month is available,and has been reviewed by the <br /> Desi ted UST erator. Attach a co o the alarm hislo r ortllo to this orm i available. <br /> 4 Each alarm for the vious month has been ras ended to a ro rials! . <br /> 5 Sensors located in tank-to containment sumps have not alarmed' :the past month. <br /> 5a List all tank-top sumps where alarms occurred in the pact month: <br /> Nwe:Sumps where an ahsrm has occurred In the past month moat be Inspected unless a quat�ed service fechnwian respmded to.and <br /> property addressed the cause q/the alarm,Almch dammenlahan wrt(ying appropriate se"ice to this report, <br /> lfjuW in ttion Is required.record results In Item a belor, <br /> UST SYSTEM INSPECTION <br /> 6 Tank-cop containment sumps are free of water,debris,and hazardous substance. Sensors are located properly. <br /> Nolc Vista!ins wren v sum !s on <br /> din sums where on atom ha,occurred In the ionja rnogth orwhich there is rro service record <br /> Y N Y N <br /> Sump Location: Sum Location: <br /> Sump Location' Sum Location: <br /> Sump Location: I A Sump Location: <br /> 7 Spill containment structures are free of water,debris and hazardous substance. <br /> Y N NA Y NA <br /> Tank I -Contents: 7 Tank 3-Contents: r <br /> Tank 2-Contents: 11 Tank 4-Contents: <br /> 8 Under-dispenser containment areas are free of water,debris and hazardous substance. Sensors are located properly, <br /> Y N NA Y N- NA <br /> Dispenser 1/2 Die eraser 9110 <br /> Dispenser 3/4 V Dis eraser l I/12 <br /> Dispenser 3/6 Dispenser 13/ 14 <br /> Dispenser 7/8 Dispenser 15/16 <br /> PAPERWORK INSPECTION Y NAI DATE DONE <br /> Monitoring system certification has been completed within past 12 months, <br /> r112 <br /> Second containment tests have been completed within the r u4vd timeffume. <br /> Spill containment structure bucket testingwas com feted within the past year. <br /> 2 `Q <br /> 'rank tightness testingwas completed within re wired timeframe. <br /> Line ti htness testin was com leted within reuired timeframe.Other re wired testin maintenance was completed within required Nmeframe. List test maintenance items below. <br /> TesdMaintenance: <br /> Test/Mainienance: <br /> Test/Maintenance: <br /> FACILITY EMPLOYEE TRAINING .. Y N 1 NA <br /> 15 1 All facility em to eas have received there iced oa-the-'ob trainingwithin the t year. <br /> 16 All fact! employees hired within the 30 da s have received the required on-the-job training. <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 I of 2 November 2004 <br /> STiOT'd ££U£89b602:01 woad 20:£0 9002-h0-170 <br />