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y <br /> Designated Underground Storage Tank(UST) OperatOlr <br /> Monthly Visual inspection Checklist <br /> -Z- <br /> Facili Name: � Date: <br /> — <br /> T Fad Address: l ' Code: <br /> C' <br /> Dom• ec1 UST for actin the on:Ton Fonwa 07 / 10 /2012 <br /> E iratiori bats: <br /> lntem oral CAde Cbuacil Certiflcatiou#: 5289227-UC Phone: 209 595-4489 <br /> $1 X a X H�1!T NA�1!toi actDle <br /> Item <br /> MQU. <br /> ALA,Rh'i HLSI'�OR'Y Y N NA <br /> 1 M is on aad m' mode. <br /> 2 Manz s toAris not curt she an alarms or has been reviewed by the �( <br /> 3 A1aT>aR b1stc" og t'vr ma previou9 month is availnble, <br /> Desi ct UST OveraUr. Attach a co a the alarm hist r ort llo to this orm f available. <br /> 4 leach alam for the evious month has been res ended to are <br /> 5 Sensors located in tank to containment.sum a leave not alarmed in the est month. <br /> 5a Lisg all milt-top sumps where alarm occurred in the past month: <br /> A <br /> Qf <br /> to the past mn*reutt be in�ede�unkuv a quay armee lechntMan MIPO udad!o,and <br /> Kok,.5�mpa valarm hod otxur►,ed Qe servlce to thts report <br /> proparfy cddrimssed the cmcx OWOlarm. tRuh doadnsn approPrta <br /> etion is ►rd rewrd results in tmm.6 below. <br /> UST 3YSTEMINSkI�gV2N <br /> 6 Tank top containment sumps are tree of water,debris,and hazardous substance. Sensors are located properly <br /> Nate:Yt�ual ctlon tr on to ea Khsn an alar+n has occumd the �!nwntA r which there tt na aervtca <br /> X N <br /> Stott Location: S�tm I,ocatton: <br /> SUMLacatfon: S'um Location:. <br /> Sttm Location:. Stun Location: <br /> 7 5 mment w ar <br /> stntatu e free of water debris and hazardous substance <br /> ill coatain . y . N NA <br /> - X N NA <br /> Tank l•- ts: `� Tank 3—Contents: <br /> Conten '�•� <br /> Tank 2--Contents: `� Tank 4—Cotrtenxs: <br /> g CJndea'dis eAser coafsinnQent areas are fret f water ldebris and h�dous snbfgtAnae: Sea4sors are located N NA <br /> Dia <br /> Dis eraser}�$ t— <br /> Dir user 3 D er 13 174 <br /> D 3• p etlS/16 <br /> LiMMM <br /> PAPER'WORT INSPCIIUN Y N NA yflkTE bC1NE1•L <br /> 9 Mouitozin steerm ctiScation has bees feted within Ast 12 months. <br /> Seco conVdent tests have bcett com feted within a tinneiiame• <br /> 10 nm <br /> 1 l 1 <br /> I l testa ares, toted within the Pao aar- <br /> 12 Tank ess to -was ca feted within time. <br /> 13 Line ' ess testis was luted witisin aired dMeft=e. <br /> I4 Outer re to Mmtanaace was co feted within retitue8 me. fst test/matrttenance ftertls below <br /> rest/Mafnt¢reance: <br /> Test/Maintenrmce: <br /> Teat/b4itintenw►ce: � - N NA <br /> FAGtLiTX'r3floWYEEIII MARC% y <br /> 1 have roocived the wired on-tire-ob. ' <br /> within the <br /> TS All fac ' once-'oli <br /> 36 All facility em 1 s hired within the 30 ��tt�ived� and wiU hire <br /> Note; answotr of uPi''should be explained in the comment section OR the following PR9 ft <br /> quire <br /> action. <br /> Papa I oft November 2004 <br />