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Designated.Undergroi;nd-Storage T (UST) Operator <br /> Montwy VisuW,Ins'pection Checklist <br /> Facility dame; c nate: <br /> Tacil!tx Address: L,C. - <br /> Ci v Zi Cdde: <br /> Desi UST O r'Condit, <br /> ctfli rho inspection: <br /> Intcmational,Code ail Ce' 'on#y, a- , .•� G Expiration Date., I I <br /> Sl' ature; a,. Phone:K Gj 163%It a3 An <br /> Y=Yue N+-No. -NotAgplicable <br /> )Item MO Nd P NEL/ALARM HISTORY Y N NA <br /> Mill milli" <br /> 1 Monitor s stein ia. wQre4 on and iii o mode. <br /> warnin <br /> 2 Monitoring s stem is trot c�rrentl .rho an alarms or s, <br /> 3 Alarm history report(log for the previous,month is available,and has been reviewed by the <br /> ------LE)esignstsd UST Operator. Attach a co o the alarm histo 're ort/lo to this kwjtavailable iµ <br /> 4 Each alarm for the Previous month has•bm re ed to a ro riatel , ®„ <br /> 5 Sensors locmatWed an.tank=to containment soft! sha,ve:not alarmed 1n th0 month. f <br /> 5a Llst all tank-top sumps where alarms ocewed in the past month; <br /> Note;.,S}rmps where an.a►arm has Cccumd to thi past mohlh must be/aspected uni@ss a qualij7ed service technlelart responded to,and <br /> Properly addressed the cautee of d a alarm Astadt doaaaenmilon verWng appropriate service to this report, <br /> rtiout i$ re reC4rd�rttlts ln.Jt6ne 6 below. . <br /> SYSTEM INSPECTION <br /> 6 7 anlc-top contaituitont silinps Eros bf war,debris,avd hazardous substance.:Sensors are located properly. <br /> ore:6!tsuai t atloti ls.o rA aired t>P.r r where an alarm has occurred in the t month or which there is ae service record <br /> Y..... N Y N <br /> Stun Loaatlon: "1 ,5wrt Location: <br /> Sutii Location:. o c �,,! ., . Sum Location; <br /> Sum Loaarion: w% Sutp Location; <br /> 7 .-- iii:coezta ;ant a are race of tor.*6 ' :sod irrttaadaus su{sxtancu. <br /> • Y N NA <br /> Tank 1—,Contertts:: Y. N NA'., ►� Tank 3 r Contents; zr. <br /> Tank-2—Contests: Tank 4�Contents: <br /> 8 Under-dig r co <br /> ntailpent areas free bfwater;debris,and hazardous substance, .Sensors are locatedroperly, <br /> YJ N INA Y 'N NA <br /> l�ls eraser 112 v Drs eraser 9/10 <br /> Dig enser 3/4 L Drs eraser 11/12 <br /> Dls errser S/6 Dls eraser 13114 <br /> -Dispenser 7/8 ✓ Dls arrear IS 116. <br /> PAPEi<t'.WORK INSPECrYON Y N NA DATE DANE <br /> 9 Momdtortn steer oaruificatirret�. n,.beott Vo leted 1within past 12 months, <br /> 10 Secon containment tests have eoeici' lett wi�in theuirod timeframo. <br /> 11 s ill coatalntnent$ ctere b. . Wilt."c.0Rpl1W within the put xMr. <br /> 12 Tank ti tress testin was'Co leted..with r ' uireiiA e&ame. <br /> 13 Line ti tress was com detect within r sil bleneframv. <br /> 14 Other r wired testin <br /> maantesnan was co let within r wired timeframe. List tesdmalntenance items below. <br /> Test/1�lalntenance:' <br /> Test/Maintenutrce� <br /> Co., <br /> FACILITY EMPLOVEK TRAINING Y N NA <br /> 1 S' tl facili <br /> OmDlowym have rowived the'reculred oa-the-'ob trafta ithin the past ear. <br /> 16 Alt factli <br /> employees hired within the past 30 da s have revel Ved the required on-the-job training- <br /> .Note; Any answer of aN"should be ekplained he the Comment sectioie on the following page,and wiU require <br /> follow-up action. . <br /> Page 1 of 2 November 2004 <br /> 2d WCET:£0 S00Z Z0 '3a(I ObSZ TZi= 9T6: 'ON Xdd 33NdN31NIdW NOIld1S30IAd3S'Z'9: WOdJ <br />