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Q _71-1477� F11 <br /> L � HLH1.hl <br /> O Fu�L ��Uh"IP ^' <br /> CiEi I I LHkI 1 � 00 <br /> 14 1 <br /> Underground Storage Tank <br /> rc. �LHF,I°I <br /> Monthly`Visual Inspection Checkl(USTs Operator U) <br /> `ql a 37 F I Date: <br /> r <br /> the Insection: Zi Code: <br /> Ton Fontana /T <br /> on#:1064273-UC \V <br /> Ex iration Date: 05 /29/2016 rF- <br /> Phone:( 209 )595-4489 <br /> r-t MONITORING PANEL/ALA HISTORY V Yes,N=No,NA=Not A lieeblel <br /> RM <br /> ed on and in ro er o eratin Y N NA <br /> entl showin an mode. <br /> 3 alarms or warnings <br /> �t h d _T o_log for the previous month is available,and has been reviewed by the <br /> ed UST O erator. A[tach a co o the alarm hiseo re or bee <br /> 4 Each alarm for the Previous month has been res responded to a to this arm i available. <br /> 5a Sensors located in tank-to containment sum s have not alarmed rintthe O <br /> LLst a!l tank-top sumps where alarms occurred in the ast month. <br /> past month: <br /> V/ <br /> Note.lumps where an alarm has occurred in the past month must be in 7 <br /> �� P Pe Y addressed,the cause nJthe alarm.Attach docu inspected unless a qualified service technician responded to,and <br /> tQ /sum ins ection is required,record results/n item 6,helow.tt verhnn8 appropriate service to this report <br /> O <br /> IN 3 6 Tank-top containment sumps are free of waterUST s,debris and hazardous substance. Sensors are located properly. <br /> Note:Visual ins coon o sum s is onl re uired n sum s where <br /> (� an alarm has occurred'"the ast month or whvch there is no service record <br /> N Y N <br /> Sum Location: �� y N <br /> Sum Location: (, Sump Location: <br /> � Sum Location: Sum Location: <br /> 7 S ill containment structures are free of water,debris,and hazardouI um s <br /> Tank 1 substance. <br /> I <br /> N Y N NA Y N NA <br /> O -Contents: nk 3-Contents: _16Tank 2- Ta <br /> Contents: Tank 4-Contents:— <br /> 8 8 Under-dis enser containment areas are free of water, ebris,and hazardous substance. Sensors are located ro erl . <br /> Y N dNA Y N NA O <br /> Dis eraser-3 Drs eraser-9,'F9 t O <br /> Dis eraser-3 i 4 Dis eraser 44,4H <br /> Dispenses-1.46 Jt Dis eraser 13/14r/1 <br /> Dis enser-ZZB C1 V Dispenser 15/16 <!J <br /> PAPERWORKINSPECTIONINSPECTION Y N NA I DATE DONE <br /> U) 9 Monitoring system certification has been completed within past 12 months. <br /> _0 10 Secondary containment tests have been completed within the required timeframe. - <br /> o 11 Spill containment structure bucket testing was completed within the past year. <br /> 73 12 Tank tightness testing was completed within required timeframe. <br /> Q 13 Line tightness testing was completed within required timeframe. <br /> EAl <br /> requ <br /> iredmaintenance was completed within required timeframe. (List test/maintenance items below.) <br /> Q . <br /> r-r : <br /> � � : ,.O SU FACILITY EMPLOYEE TRAINING Y N NA `V <br /> O ave received the r uired on-the-'ob train' within the ast ear.ired within the ast 30 da s have received the required on-the-job trainin . <br /> c77 1 !Vote: Any answer of"N"should be explained in the comment section on We following page,and will require <br /> follow-up action. <br /> o O <br /> �I page l of 2 November 2004 <br /> N .--t <br /> 00 <br />