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Desig;uv4ted,•Undergrpun&,.Btorage T (UST)'Operator . <br /> l 00#1ly.vi�4.�z speorion' Che lJ4 t <br /> jlityName: ' gst4: <br /> Faciiit •Address' <br /> Ci• � • . . . •� . ' .2; •Godo' <br /> � b• <br /> Aesi *d USTOperator'Conducth °thetdns action; <br /> Intern onat da ouncil Cert1 oat$on'#� 'B ireition ate:. <br /> Si •Phone; �• <br /> To Wei Nis No,NAWNotA tewble <br /> item <br /> MMUTORIN PANEL/ALARM HISiY3RY ' Y ,N WA- <br /> 1 Monitorin s steni'ts o axed op 'd' ' r owding mode. <br /> 2• Monit'orin stem is riot cat:rrentl ,phdwW a alms or warnin s. <br /> 3 Alarm history reporVlog for Oe prev.ious•mbnth is available,and as beep reviewed by the' <br /> Desi ted 1JS O 0ratof. Attach u co 6the.al )n Meta) •'re ort/lo to this orltm'' available, <br /> 4 Each aiann fair the' revious month-has beeli rai nded to tb ri to , <br /> 5 Sensors located iei.tank oto contaitunerrt sum s havo4ot alarmed Ih.thd pjwt month., <br /> 53 List all&nk-top swhere alarmv•occurrepl,the past mQnth: <br /> ' lyoai•saanaps where py,alarm ha:eccuired!n tki'�at metrtA•rawr be hupeo'teal�altrai a gaaal(fted seevlce rachntcJan reapandad to,and <br /> Pr r I)'addnesreit the cgwy of rhe alarm.ilttaeh dooururontdrlon vlr4�Hn8 appropitate rrPYtrs to rhG+report. <br /> swm ins• ctlon a 44014d,ricl4restrits In•Itaarn F,below. <br /> ivft'SYSTxM•IN P=CON <br /> 6. Tank to'p cmintainmein;suiitps: a free<dfVvdl�r,¢abfis,anti him ous Zitanoo Sonsors•are located properly. <br /> ore;'E'tauat action cram /s o re ind fan a where analareo hao occta�+ect 1n rhe Rtotsth or wlrlch there flies nrvlce vrscerd.' <br /> Y. Y N <br /> Sum Location• Sunt •Loa len: <br /> Sura Location: tit LocaPlan: <br /> sump 4,Matlon: Smuh"Locadom <br /> ' - <br /> Y ' NA Y. N NA <br /> 'Cairk 1--ConMna: i T 3�Ce writs: <br /> Tank 2—Contents: ,. EE. <br /> 4--Contl3trts: <br /> 8 tJbdor-dis• eraser cop i e t areas re frea-�bf wat Y,` ebris 'and hazardous stfttanco. Sensors are located properly. <br /> Y j Tjj NA Y N ' NA <br /> . D/s eraser /Z • • .D eraser 9/10. ' <br /> Dir eraser 9!4 Dia sns�J 1/12 <br /> Dts err�ep S/d' X7 13,/14 <br /> Dlf eraser /8 •. DIS ehsrer!s/76 <br /> • 1?APE)tWOIZIC INSPECTION Y ' N NA DA'Z'E DONE <br /> 9 mohieardfioa io0 etwWin past 12 months, <br /> s . <br /> 10 Sooneontainmottt tests have bgpn coeg1 lee'dt +wid&the regulved timeframe, <br /> 11 S i11 containment's c ro u-.e toe in lebsd thin tiro ast bar: <br /> 12 <br /> Tadd tness testingwas o I e ;withi. r ' u etiamo. l� <br /> 13 <br /> Linc ti tness tcstiri •was GQnm letcd within re timdiiatna: ` <br /> • 1,4 Other re4utrad testin M41rifeiiance wDs oom let' ith uirod•titreotramo. Ltart resl/malrrtenan"teems slaw, <br /> Test/Malrrtetngnce:•' .. �. <br /> T�st/Matntenance; ' <br /> . 7'esb'll�alntcnance: <br /> FACILITY EMP LO •9E'TRAY N 7NAJ <br /> 1 S"I Ail facili ata to ceg liieve received tlte'rocidind ot'f-tho-ob ftin thin thv Pat Year. <br /> 16 1 All'thellity emir to ees hired within the pitst 30 ftyo have receKed the re uirvd.an-the-ob tra i <br /> Note. Any answer of"N".should be ckplalned in the coaemeint®actiots bn the foilovKiia$page,and will require <br /> '. . follow-up action. <br /> ,. h., ®'1 oft' Novoi fiber 2004 <br /> TTd WdZti:20 S00Z ZO '0aQ Ot;SZ tiLE 956: 'ON Xdd S0N6NS1NIdW N0Ild1SS0If1J3S'Z'H: WONA <br />