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Designals Underground Storage Tank (UST) aerator <br /> Monthly Visual Inspection Checklist <br /> Facill Natnc: Date: Al-140- <br /> 0 ; <br /> "aci lity Address: -1716 o re_: <br /> -;'it : +-p C Y-N Zip Code. LZ <br /> Design4ed UST Operator Conducting the Inspection: Lori Freshour <br /> International Code Council Certification#: S 2203 3-LA C Expiration Date: 1 b -t L.- O 5- <br /> Si attire:' Phone: (916)826-1576 <br /> Item MONITORING PANEL. AIARM HISTORY Y N NA <br /> 1 Monitoring system is powered on and in lyopur operating node <br /> 2 Monitoring system is not currently showing any alarms oewarnings <br /> 3 Alarm history report/log for the previous month is available,and has been reviewed by the Designated UST Operator. <br /> (Attach a copy o the alarm history report/log to this orm i available) <br /> 4 Each alarm for the previous month has been responded to appropriately. <br /> 5 Sensors located in the tank-top containment sumps have not alarmed in the past month /►1 <br /> 5a List all tank-top sumps where alarms occurred in the past month: *VI E <br /> Note:Sumps where an alarm has occurred in the past month must be inspected unless a qualified service technician responded to,and <br /> properly addressed,the cause of the alarm. Attach documentation verifying appropriate service to this report. <br /> If <br /> sum inspection is required,record results in item 6,below. -7- I 7 IZq I W/ <br /> VIST SYSTEM INSPECTION <br /> 6 Tank-top containment sumps are free of water, debris, and hazardous substance. Sensors are property located. <br /> Note Visual inspection of sums is only required in sumps where an alarm has oactrred in the st month for which there is no service record <br /> Y N I Y N <br /> Sump Location: RE4 S ocation: <br /> Sump Location: P&e Sump Location: <br /> Sum Location: p t G Sump Location: <br /> 7 Spill containment structures are free of water,debris,and hazardous substance. <br /> Y N NA Y N NA <br /> Tank 1 -Contents R t5 Y Tank 3-Contents t <br /> Tank 2-Contents p E ` Tank 4-Contents V p o- \L 7- <br /> '8 <br /> -d UDC areas are free of water,debris,and hazardouspsubstance. Sensors are properly located. <br /> Y N NA Y N NA <br /> Dispenser 1/2 Dis enser 9110 PA <br /> Dispenser 3/4 Dispenser 11/12 N Iq <br /> Dispenser 5/6 Dispenser 12/13 /u R <br /> Dispenser 7/8 Dis 'enser 14/15 to A <br /> PAPERWORK INSPECTION Y N NA DATE DONE <br /> 9 Monitoring system certificafion has been cornpleted within the past 12 months. -p <br /> 10 Secondary Containment tests have been completed within the required timeframe. N A <br /> 11 S ll containment structure bucket testing was completed within the past year. y -o <br /> 12 Tank lightness testin was competed within required timeframe. hl <br /> 13 Line tightness testing was completed with required timeframe. tq <br /> 14 Other required testing maintenance was competed within required timeframe. List test/maintenance items below <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> FACILITY EMPLOYEE TRAINING Y N NA <br /> �Afl <br /> l facility employees have received the required on-the-job training within the past year. y <br /> facility employees hired within the past 30 day have received the required on-the-job training <br /> Note:Any answer of"N"should be explained in the comment section on the following page,and will require follow-up action. <br /> Comments: e T S <br /> • Sj L, 6 A ouf_ A L, L L-rO N je EA OT I C> . <br /> ollow-up action required: LO t t_t- N t S >} 319 1 1 Irl l N& AL A R(K.0 <br /> Deafer I Manager Signature: Date: <br /> a <br />