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=rn - d �' <br /> O0 m m <br /> Yo — O ° a <br /> CD NC <br /> N U:NDF, <br /> ° RCROUN U ti I t 1to <br /> DES(GNA7'ED Ub"P It <br /> z f)RFRA'f(lit \lll\ I III 1 11�1'I to A <br /> EfWvrct� IIt1\ Rt:PORT m o0. m <br /> r) <br /> CD <br /> J <br /> r�Paraor r4nvju It(, 1 ` <br /> 77 uuuul'.utrfKyron Vii, ' P <br /> e -...�.,.•�`\. - y� J )L4 r:apeuwn Gate f _—Q. N <br /> -4 OD <br /> i t, _ ' - --�3-I V _ _ C) O <br /> 14n.131. eu ,�' _ -4 O <br /> NC 4) r N <br /> �hluen —.____MON1'f011N(' we.ease C, <br /> wnnorio •-.VANR1 wnLANM 1113TONY A to O <br /> .�. r Ppwned ai arM myroPcT nm mudtY WA d <br /> '@✓ m astern ool - - -° O1 _lt__-....-.. __. _-.-.__ Ye+ a <br /> uu'resN showin - -- a <br /> AIK Alarm Hun he --us IWc alarms? ---- —_--__ <br /> w' ory 1[epaVlog for tlx P, us month available,aM hu n ban renewed by the r <br /> dRO�° o the u)urm h/aro r Co- <br /> wm Warm for Ibe iuua month �' V(--°R to this s r -T y <br /> _ _ naedlo apprnpriarely, _ �___ <br /> hse tari:-top contain USTSYSTEM lhi Pl i u r - ,•. _....-....� 3 <br /> ro hem 6 say+ moem PS free of water,debrns ar�d r to <br /> rrir hoe ou a N r6r '���ce7 Nur Us <br /> -U re I Ismlwr-ro•tl} <br /> N Kier evau tae a1am Gxymrmumn K Nh ✓I ;:: 1. <br /> ' 'r✓Kd trchm[Ipn au ro' <br /> g+_u mrv�cr ahar(�errarh_dro thu <br /> Pilot <br /> Location: Ya N° p- <br /> Sum ""'rlon: Sum - Ya <br /> ' cation:_ � <br /> hre spill buckets(conaimncnt atNctme� Sum lgcation: 3 <br /> of water,debris,and hvmdous substance? CD <br /> 'r - Yo N/A N� <br /> Tank l 1D- -� N - p <br /> '1211k22 ID- -.._-_ Tank 41D- <br /> Va o : NIA <br /> 'ark° 1t,- -- Tank51D- <br /> hre under-di se•<-:.,; . - — Tank6ID- - <br /> - debris and haeardow substance? <br /> - 1.2 <br /> NIA <br /> Yes No NIA <br /> Dis user-9110 <br /> Dis enxr-11/12 <br /> Dis enser-13/14 <br /> Dis W-15/16 <br /> deles4ion� f"-" - . .:,,er containment. <br /> -l2 Dis enser-9110 Yes No N/A <br /> -316 _ ✓ Dis ser-11/12 <br /> _. —I)'is enser-13/14 <br /> -7/8 td`1..j L is enser-15/16 <br /> PAPEK WOKK INSPECr10N <br /> hoririX System Certification was cont feted within the ast 12 months? Y ° N/A Date Done <br /> Deteaora were ItVedlcertified within the past 12 months? 1 <br /> I oucke (containment structure)testin com feted within the ast 12 months? <br /> li.'mla-ss rs!irt>;cum {eted within the required time frame? `4 t <br /> ntl v ontainrnem tests curnpleted within the required time frame? _ <br /> rrtc _.ear. ✓nct;Q rorupletbd within the required time frame? <br /> p-yw::f testir4raunenance was cont feted within required time frame? (Liss resrhnaintenonce items below. ' <br /> u: 1aVlJcimenartcr- ❑ <br /> Willenam& - <br /> - m <br /> O <br /> FACILITY EMPLOYEF,TRAINING Yes N/A o <br /> received the requited on-the-job trainin within the est ear? <br /> aI to v <br /> 61' oni rtvtt* F p ' hind within the est 30 da s received there uired on-the 'ob trainin '? ❑ <br /> to <br /> y answer; it the "Comments"section on the following page.Those issues require corrective action from <br /> OD .`rllpe'aIT o <br /> O N <br /> W <br /> www.unidoa.org 9h rn <br /> A W <br />