COMPLIANCE INFO_2005 - 2012 - Laserfiche WebLink

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Designated Underground Storage Tank(UST, —perator Monthly Visual Inspection Checklist Facility Name; k.JU Date: 2_j y-05 Address: p City: Zip Code: Desi ed UST Operator Conducting the ion: Lori Freshour Imernational.C94c Coun ' Certification#: 2z0 — Si Phone: (916)826-1576 Item MONMRING PANNI ALARM HISMRY Y N NA 1 Monitoring systm is powered on ant in proper opcirating mode 2 Monitoring system is not currently showing any alarms or wamings 3 Alarm history report/log for theorevioas month is available,and has been reviewed by the Designated UST Operator. Attach a copy of the alarm hist report1log to thisform if available 4 Each alarm for the previous month has been responded to appropriately. Njq 5 Sensors located in the tank-top containment gunps have not alarmed m the past month 5a List all tank-top sumps where alarms occurred in the past month: Note:Sumps where an alarm has occurred in the past month must be inspected unless a qualified service technician responded to,and ,; properly addressed,the cause of the alarm. Attach documentation verifying appropriate service to this report. I sum ins on is required,record results in item 6,below. UST SYSTEM INSPECTION 6 Tank-top containment sumps are free of water,debris,and hazardous substance. Sensors are properly located Note:Visna!YLVechon of sLmnps is in sumps where an alarm has wwred in the Pad month for which there is no service record Y I N Y N Sump Location: Sump Location: Sum Location: Sump Location: Sum Location: Sump Location: 7 Spill containment structures are free of water,debris,and hazardous substance. Y I N NA Y N NA Tank 1 -Contents �t r`I L Tank 3-Contents L7 l t✓ Tank 2-Contents i'h= Tank 4-Contents \/,E-" T- -f- 4� 8 UDC areas are free of water,debris,and hazardous sulastance. Sensors areproperly located Y N NA Y N NA Dispenser 1/2 Dispenser9110 Dispenser 3/4Dispensor 11/12 Di nser 5/6 _____f Di nser 12/13 Dispenser 7/8 _PL14/15 PAPERWORK INSPECTION Y N NA DATE DONE 9 Monitoring tem certification has been conripleted within the past 12 ntorlths. -Ct-o 10 Secondary Contaimrent tests have been eted within the 'red timeframe. A ,� 11 Spill contairunent structure et testing was conoeted within the past year. _ �- 12 Tank fightness testing was cornpleted within required timeframe. 13 Line tightness testing was completed with mWired timeframe. 14 Other required testing maintenance was cornpeted within reWred timetrarne. List test/maintenance items bek)w Test/Maintenance: Y Test/Maintenance: Test/Maintenance: FACILITY EMPLOYEE TRAINING Y N NA 15 All facility have received the required on- ob h-aining within the past year. 16 All facility hired within the past 30 day have received the mquired on-thojob training Note:My answer of"N"should be explained In the comment section on the following page,and will require follow-up action. . --rolleiw-up action required: Dealer i Manager Signature: `r Date: