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d -a vw <br /> O N ID <br /> v 0 o a <br /> CX. <br /> G) <br /> aUNDERGI2OUNI) i'I' <br /> 1 <br /> � MSIGNATED UST OPFRA'TOIZ MON' <br /> ON J , y <br /> . DANK <br /> 10 <br /> FaciliryName: til'I,(,'l ION Itf. t <br /> N Colonial Gergy CE# o <br /> Facility Address: _ In:p«nun Uatc O <br /> 0 <br /> N Name of Desi --- l ? I'il <br /> Co - gnatad USTC:11 <br /> H w City J <br /> operator Concludinins CO p N2 <br /> International Code <br /> N ' Council--_-fica{o -N-. a _iG- !rj ?•�• <br /> O <br /> Signature: iie o <br /> _ 1j <br /> 07 V eSKo <br /> d Itemt- <br /> MONI'rU1tINC P t l°'1 a�<,41 ext. 0 0 <br /> N 2. Is the monitorin sstem owered on and in to cprNEL/ALA_'�RM�ilS rfrlty t`A-Nsta was rp <br /> is the monitorin s stem not cuMail show, an sun randel ==__.__,Ye§ NIA r� O <br /> 3. is the Alarm Histo '13 <br /> Desi nated UST rY Repo Tor the previous month available, 0 a <br /> Operator! (Attach o co o the alarm and has it been reviewed <br /> 4. Has each alarm 1'ur the revs"".nnnrth teen ra onded to/ar re rl/lo to this!nr �•the W <br /> r !I <br /> std Sedan arm, k o <br /> 5. Are tank-to c UST TEMINSPBCTIUN <br /> 10 nem 6 p ontainmcnI Is free cr debris,and h--ION w - (p <br /> Sumps ivherc an nlann Ina rd r tl r .,dou§§ubuance7 <br /> a r/ add uxd lla ra a monrA mwr ba!n Noa:Il da armor ry lam f va�'Ya'rFrp <br /> nrro arm/Jac n_emnllon art In a yxgtd Ila Walprod-I aclrnldan <br /> _Yea No ra ttlroWdprgy�,w 191 •rrpm@d w.and O <br /> Sum Locatio t D <br /> Y <br /> Sum a No m ton. - Sum Location: tz <br /> 6. Ares ill buckds containment mn <br /> 'tures)free o(waler debris and ha»rm <br /> m <br /> Tank 11D_ <br /> Yes Nu N/A dons substance? 0 <br /> Tank 21D- - 'yank 4ID- Yes No N/A ° w <br /> Tank 3ID- _ Tank 5ID- 0 <br /> 0 <br /> r 7• Are under-dis enser containment areas frac of water,debris and hazardous substance? 0 <br /> Yes No N/A <br /> C1 <br /> Di rater- 112 Ya rya N/p <br /> Dis enser-314 Dis enser-9/10 0 <br /> 0 <br /> Dis enser-516 Dis enser-- 11/12 Z3 <br /> Dis enser-7/8 Dis enser- 13/14 <br /> Dis enser-15116 <br /> 8. Leak detection is to rl located within under-dis enser containment 3 <br /> m <br /> Yes No N/A — --- <br /> Dis enser- 12 Yes No NIA <br /> Dis enser-314 Dis ensu-9/10 <br /> Dis enser-516 - Dis enser-11/12 <br /> Dispenser-7/8 __ Dis enser- 13/14 <br /> - Dis enser- 15/16 <br /> PAPERWORK INSPEC•riON Yes No NIA <br /> MonitoringSystem Certification was completed within the ast 12 months? Uafe Done <br /> Line Leak Detectors were tested/certified within the past 12 months? _ <br /> S ill bucket(containment sVucturc testin com leted within the ast 12 months? <br /> Line ti hiness testin com leted within the re uired time frame? 11�t <br /> Seconda containment tests com Ieled within the required time frame? <br /> Enhanced Leak Detection completed within the required time frame? <br /> Other required testing/maintenance was completed within required time frame? (List lest/mainrenanee items below. <br /> Describe Iest/Maintenance: _ <br /> Describe Test/Maintenance: <br /> FACILITY EMPLOYEF,'TRAINING m <br /> Yes o NIA 0 <br /> ve all III em to ees received the re-Wired on-the-'ob trainin within the ast ear? <br /> n <br /> ave all facili employees hired within theast 30 days received the required on-the=ob Isainin ? p <br /> Explain any"No"answers in the"Comments"section on the following page.Those issues require corrective action from <br /> the UST owner/operator. <br /> ° s7-Irz o <br /> A "munidocs org 9/26Mw <br /> rn <br /> w <br />