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I,3esignated`Underground Storage Tank (UST) Opaator <br /> ;o Monthly Visual jnspectiofi Checklipt <br /> Faeili Name;. ,,� Date` <br /> b Facilit.Address: a ' <br /> �zn <br /> City: e` L Zip Code: <br /> Desi natedST Operator Canductin the Ins ,ection: <br /> International de Co cil C®rtifiea'tiori#s iration Date: -Z—/ 3 / <br /> Si at PPhh one`( } �` 1 —_ <br /> _)F_—Yes,N=No NA N-o—tA-60fes b!e <br /> Item MONITORING PANEL/ALARM HISTORY Y N NA <br /> mmmiiiiill no <br /> I Monitoring s stem is pow.q4.op agTin. rq er op Gratin mode, <br /> 2 Monitoring system is not currently.showing an a,�warnings, <br /> 3 Alarm history report/log for the previous month is available,and has been reviewed by the <br /> Desi aced TJS'i'Operator. �ittacF;a co •o the aldrin histar 'r! epart/I -to this form (f available.)._._____ <br /> 4 Each alarm for-the previaus month bas beeti responded to appfoaiately. <br /> 5 Sensors located in.tzank•top containment sumps havemot alarmed in the past month, r <br /> Sa _ Uo all rank-top sumps where alarms oocurred.,in the past month. ___ <br /> 4 <br /> Note.-Sumps where an alarm has occurred in the past month must be lr a rcted unt8ss a qual Uled service technician responded to,and <br /> property addressed the cause of the alarm.attach documentatlon verWhS appropriate servtce to this report. <br /> 1 Gum l BCWon is re utred,record-results tn.ltem 6,below. <br /> '69T SYSTIEM INSPEC rioN <br /> 6 Tank-top containment sumps are free of v✓atei,debris,and hazardous substance. Sensors are located properly. <br /> �, ole:Ytsuat!ns ection sum s ls,ottt re ufred4n:eum�s where an alarm has occurred in the pa:t months for which there is r:o aervicc reoord <br /> Suing Location: Sum Location: <br /> Surnp Location: - Sump Location: <br /> SumLocation: Sump Location: <br /> 7._. • iFl ort+Ginau.att attctett�re fi'ec�rr'w�ttseailrt5 att4i httssuat8'iGC ' -�---' ' <br /> Y N� NA <br /> Tanis 1 —Contents; <br /> Tank 3-G'onor <br /> lettts: <br /> Tank 2•-Contents: Tank 4—Contents: <br /> 8 Under-dispenser containment areas•are free"of wate'f,:debris and hazardous substance. Sensors are located ro eel . <br /> Y N .' NA Y _N A <br /> Dispenser 1/2 _Dispenser 9/10 <br /> µDfs enser 3/4 Dis ensdr 11/12 <br /> Dispenser 5 1'6 Dis enser 13/14 _ <br /> Dispenser 7/B D1senser, 1 ./16 <br /> PAPERWORK INSPECTION Y N NA DATE(DONE . <br /> 9 <br /> Monitoring s stem certification°6a&.-bee6roin feted within past 12 months. / <br /> 10 Second eontainment.tests have been cash feted within the r ••aired timeframe. <br /> !I Spill containment structure. aq <br /> ket),t.Psflnj.W#s completed within-the past-Year. <br /> 12 'Tank ti fitness testing was com le ed•within required timeframe. . <br /> 13 Line.0v testitesti:was cpcpm leted within ro uired timeframe. <br /> 14 Other required testin&/maiatehance was cosnpldted_within required timeframe, (List test/maintenance items below. <br /> Test/Maintenance: <br /> TestlMaintenance:' -, <br /> Test/Maintenance: <br /> FACILITY EMPLOY•EXTRAINING �..P Y N NA <br /> 15 All—facility employees havah trainin2 within the oast year. <br /> 16 Al!•facili crn to ees.hired within the gast 30 daXs have received the re aired on-the•'ob trsii . <br /> Note: Any answer of'IN"-should be ekplaiued In the comment sedlon on the rollowing page,and.willrequire <br /> follow-up action. <br /> 'Page 1 of 2 November 2004 <br /> ETd WdBT:£0 S00Z ZO '°aQ Ot7SZ TZ£ 91:6: 'ON XUd 3ONUN31NIUW NOIlU1S30Ifd3S'Z'H: W08J <br />