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Designated Undergmund Storage Tank(UST) Operator <br /> Monthly Visual Inspection Checklist <br /> Facqty Name: Date: -�.. <br /> Facility Address- Zi Code: <br /> Ci <br /> p0S' UST r Contlactm the Ins action:Tom Fontana iradooa Date: 07 1 10 12012 <br /> Intern>itlanal Code.0 Cil ora#: 5289227-UC Phone: 209 )595-4499 <br /> S' atare: Y+Yes N-No NA-N4A able <br /> item MONnVRING PSL l ALARM -aftORY Y N NA <br /> 1 MsystemispLn eyed on and in � • <br /> 2 Montt s <br /> stem-is not cured sl�oLITalarms ar warnin th <br /> s. K <br /> 3 Alarm hisWry o8 for the previous MO "available,and has been.reviewed by <br /> Qktlle <br /> Des' sled UST <br /> Operator. Attach a co o the al[l:•rrt histo r ort/lo to this form f available. <br /> q Each alum t or the previous month has been ondedto to <br /> 5 Sensors located in tank-te containment sum have not alarmed im the Dag month. <br /> Sa List alt tanl�top sumps where alarms occurred in the past month: <br /> fa fhe mOestls R++trf be tmksa a gunloW service tecJtnlcirao tesponded to,and <br /> Note;Sbmgu whdr+a alt alam has wcwytd � aGervfcs to this report. <br /> armor addmaed the er W 0the stem.,tile,*d=0w=WI e> ng�PrWe <br /> mmdred rgoord r wlo ire lo",6.b4c w. <br /> Y3 SYST19M R4SPEC TION <br /> 6 Tank-top containment sumps are free of water,debris,and hazardous substance. Sensors are located properly. <br /> Note:Vf4wl coon fs irid to whM an alarm has or cwwd fn rhe a.LI month fur which there is Ysesvlce <br /> Y N <br /> S j poatton: S'um Location, <br /> S Location. Sum Locat►`on:. <br /> Sum Location:. Sum. Location: <br /> 7 S ill containment structures are free of wad,debris hamrd°us subsunce. Y N NA <br /> Taulc 1-Contents: Tank 3-Contents: <br /> Tank 2-Contents: Tank 4-Contents: <br /> 8 C3nder�l . ser containment areas arc free of vvaw,dabr <br /> Is and hazardous subsfnnce, Sensors are ldcatsed <br /> Y N N,A, Y N . NA <br /> Dis eraser, 1.14 <br /> D er I1 J 1.2 —1-1 K <br /> Drs enser�3-t+f''?-^ D er 1 /14 <br /> D' enser�'T1T l- <br /> X1ts rtf� 9.� �• <br /> DjApmer 15/16 <br /> PAP3�AWO1lilIC INSI'ECrION Y N PTA �1,4T}s D01 <br /> 9 Montt s certification has been coca clad ti <br /> within > 12 <br /> 10 Seco conffiinment testa have hese co kted within.the d dinegame. <br /> I 1 S lll cbutaiuruent sttlscture to was completed within the set. <br /> l2 Tank tress VM; leted withhtt tlronframe' <br /> 13 Line ' tress tcstin was <br /> completed-within aqnLuvd timeframe. <br /> 14 Other it ed nnatntzzllace was c lcted witbm ed tims8'ame, !sr test/maintenance stems below, <br /> TesdMaintenance. <br /> �'est/Afafnteitmsce: <br /> Test/Matrrtentarta: <br /> FACULM EMPLOYEE TRARUNG Y ' N' 1�IA <br /> 15 All fact!' 1 have received there ' don ob ' within �• <br /> 16 All facil. em 1 aces hired within the ast 30 have received the d on-the-ob <br /> Note: Any answer of"N"should be explained in the comment section an the fonowitng page,and will require <br /> tallow-up action. <br /> Pale 1 of 2 November 2004 <br />