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Designated Underground Storage Tank(UST) Operator <br /> Monthly Visual Inspection Checklist <br /> Facili Name: Date: l 1 <br /> Facili Address: 1100 Itt <br /> Ci Zi Code: <br /> Desi ted UST 2porator Conducting the action:Tony Fontana <br /> Internati mal Code CopnoU Ce cation#:5289227-UC E ira6on Date: 07 / 10 12012 <br /> $i ature: Phone: 209 595-4489. <br /> v w Yee N=No .. A a Not A ¢able <br /> Item MON1CfQRIl1fG PANETE./AGAitM>�L4'i'ORX Y 14 NA <br /> I M is on and in P opaving mode. <br /> 2 Ivionito• stett-is not cuxteii showing arty alarms or wwnin . X ._ <br /> 3 Almm hiatary reportElog for the previous moszth is available,and has been reviewed by the X <br /> 'hiss roravailabl <br /> 13esi ted UST erator. AttacFt a co of the alarm tllo to this ornt e. <br /> 4 Each alarm for the p2vioijs month has been responded totno rtgtel . <br /> 5 Sc sqn located in taak-M cmtafimemt EnN have not alarmed in the past month. <br /> SH List all tanl,top sumps where alarms occurred in the past month: <br /> Nass:Swaps whem an alarm has occur red to dw past morn t mud ho ftreraed smleas n qualified wn re tChnidan responded to,wd <br /> property addr&=4 the ca=of gv clarnr.Attach d0cwm talon>�ymg q47prwriate.service to this report. <br /> 1 ! olio»b WiWA <br /> read&to item.6 below. <br /> UST SYSTEM INSPECTMN <br /> 5 Tank-tap wntainment sumps are free of water,debris,and hazardous substance. Sensors are located properly. <br /> Note:VL=l t coon o s is on re trod fn where an alt>rm has oo=rrsd in the t month or which there a w <br /> Y <br /> Y N <br /> Sum Location: Stem Lacatlon. <br /> Surop Location: Sum Locsation.,. <br /> Sum Location; Sum Location: <br /> 7 Sill containment structures are free ofwZr debris and hazardous substance- y N NA <br /> . 7t' I N NA <br /> -Contents: Tank 3-Gontettts:. 01 <br /> Tattle 1- <br /> Tank 2-Contents: 1'g Tank 4- Contents: <br /> B Under-dis er containment areas are free of water,dahris and hazardous subst nce- Sensors are loeat�d N NA <br /> Y N NA <br /> Dis Paert-11-2 t-(,. D enser-944$' <br /> Des ewer 344 D' eraser 11 (12 <br /> D� user <br /> 3-4 D user 13/14 <br /> p 7/8 �D_ls "ar 1S/,16 <br /> PAPERWOPJC WMC EMN Y N . NA DATE DONE— <br /> 9 Manitorin em oerti$icstion has been feted within sat 12 monnihs. <br /> l 0 Seco containment tests have been lcted <br /> within the wed timefrafne• <br /> 11 Sill contaiiuucnt structure t to was w Ieted within tho est car. <br /> 12 Tank ' mesa testlri was caro letod within titneframa• <br /> 13 Line ti tress tester was co feted within aired timeframe. <br /> 1.4 Other d tP ' tenauce was com levA within r timeframe. List tP4t/maltitenmece Items below, <br /> l'esWaintenance: <br /> Test/llfatntenance: <br /> Test/MaintenaAce: ' <br /> FAC1l1l.1TY EMPLOY T'1tA NTNG Y N NA <br /> 15 All facile em to ees have received there on-the-Ob trainer within the iugMear. <br /> 16 All facili 1 oes hired within Eha t 30 da s leave received the re a 11 wire <br /> Nate: Any answer of aN"xhauld be explained in the comment section on the folio <br /> follow-ap action. <br /> Page 1 of 2 November 2004 <br />