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Designated Underground Storage Tank (US's') Operator <br /> Monthly visual Inspection Checklist <br /> F acili Name: <br /> Date: i <br /> Ct <br /> r� FflClti �idfltes8: <br /> Zi Code- <br /> CirdA <br /> Desi ted UST Operator conithe Ins action:Tony Fontana E iratiah Date: 07 ! 10 rl0 l2 <br /> Ir,ternativnAl Cod Coullcil Cert�Jlcatiou#: 5289227-UC Phon$: 209 595-4489 <br /> No NA'"Not Applicable <br /> WO—N M.Q PAM/ALARM HWORY Y N NA <br /> t3m <br /> - <br /> M - is on and in mads. <br /> blutori t stem.is not currentl showia alarms orwarm s•Alarm history zepoitJlog for the previous month is available,and has bean mvie�wed by the <br /> Des' ated US erator. Attach a co M o the alarm histo re ort/lo to this orm t avatlabl� <br /> 4 Each alarm for the revious month has been responded to ro tel . <br /> 5 Sensors located in tank-to containments 5 have not alarmed in the past mantis. <br /> Sa - List all tank-top sumps where alarms occurred in the past month: <br /> ted unless a quaj*ed wrv+cg telh m�C=ruspon,*d ro,and <br /> ltiott: s wham an alarm hats ocervred to rhe pas.monde W It be ft pec 31-1111 to fists rerPort. <br /> projpsrlyaddress84 the r="4f thv alarne.4tti doamwntattnn wrt5ft aPFmA�B <br /> Ctlo id. recv►�rssrrlUln um.6,.below. <br /> LIST SYSTIM iM- ON <br /> 6 Tank-top eantaimmcnt sur�aps are fxee of water,debris,and hazardous substance. Sensors are located properly. <br /> Nota:Vtsco on su s u on r tred to h <br /> s where an alarm ad occur"a m the t month which there is l c <br /> Y N <br /> .Sum Locution: Sump Location: <br /> Sum Location: Sum Location:. ; <br /> Location-, Sura Location: <br /> Sum Location-, <br /> 7 nd hazardous substance. <br /> S ill containment structures are free of water,debris,aY N NA <br /> -- Y N NA <br /> Tank l--Contents: �'-? Tank 3-Contents: � <br /> Tank 2^Contents: Tunic 4—Contents: ly <br /> $ Under4l.. enscr cor►taiurneut areas are free of water,debris and hazardous substance. Sensors ars ideated N NA <br /> Y N NA <br /> DO eraser 1/2 L'' en.ser 9110 <br /> D ��3/4 Dis eraser 11/1 Z �, <br /> D' eraser S/6 Dis eraser 13/14 <br /> er1S/16 <br /> Dls er.7/8 y N NA DATE TONE <br /> PAPERWOTtICgp$GTtON <br /> g cc U)13 has be6II Ieted win ass 12 masiths. <br /> 10 Secondary containment tests have been co Ieted wittua the d timeframe. 1,d <br /> 11 S ill contsiriment sttuctwe ucket testin was c lased within the test ear. <br /> 12 Tank ass.testiti i Completed.within ' <br /> 13 Line ti ess testin was lased within re <br /> 14 Other uirel testis ntainienance''�c0m ictal within r fired timefxama. List test/maimettrntce items below <br /> T&WMaintencmc'e: <br /> Test/Maintenmtce: <br /> Te.WMaintemtrlce: N NA <br /> FACILITY EM ILOM � n She car. <br /> 15, All%cili a to acs have received the on-the-ob tm <br /> ulinglb All 1acili 1 ees hired within tatepast 30 da s have receivedeon on e foRowinng Page,:z reqult�c <br /> Notes .ray answer of"N"001310 be 91p}aitted In the cum <br /> ment sertl <br /> fouoi action. <br /> page 1 of 2 November 2004 <br />