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Designated'-Underground!.Storage Tank (UST) Operator <br /> Monthly"Visual'Inspection(Checklist <br /> Facili Name:, 4P D l t. c. R' We: Z-S" . <br /> FaCiII .Addreas: o <br /> Ci G7l GR Zi Code; <br /> !Desi ated.U t Cond4ctin 'the;Ins ection: J.-O a� <br /> Internationa Code C c I C A' <br /> Si fiture: Phone; <br /> NA <br /> Item MONITURING PANEL!ALARM H1STO.RY <br /> t101 <br /> 1 Monitorin s stem•is owelred,on aard'in. er o e�din mode. <br /> 2 Monitorin s stem is not current! .phowin an alarms orwarnings, <br /> 3 Alarm history report/log for the previous-mbnth is avaiiable,and has been reviewed by the <br /> Dfasignated UST'O erator. Attadh a ca o the dlarm histo -re ort/lo to this orm'i available. <br /> 4 Each alarm foi the previous month has been responded to appropriatelX. <br /> 5 Sensors located In.tank=to .conttainment SUM22 havemot alarmed in the fast month, <br /> Sa is all tank-top sumps where alarms occurredin the past month:tZQ'jj t om,w•Q — N b 10 O% A-At <br /> o - C - +A.nrtwtmr. 'l~'twiaaa 5-&scv` ..�..�.. .. <br /> Note;sumps where an alarm has occurred do the past month Must be inspected unless a quaI#7ed mrv►ce technician responded to,and <br /> properly addressed,the eau3.e ojlhe alarm.rf tiaclr documentation veroing appropriate servlee to this report. <br /> 1 sum ins c[lon f3 re uireci;recordresults in.itenr 6,below. <br /> _ T Y rfkM IN PECrI0N <br /> 6 Tank-top contaiumont sZos 4e free 6f4ater,debtls,and hazardous substance. Sensors are located properly. <br /> TI�Vofe:Ylvwl!nv ection' su aor which there Is Gf on Irsd n:sum s where an alarm has occurred in the est Moreth no•servlee record <br /> X.. , N ; Y N <br /> Sum Location; I ASttm Location: <br /> Swmp L®carton; spmp Locatlon: <br /> Sump_Location: Sum Location: <br /> .. ..'�• t}1-{�ntEliItl'7►bixt'3�tCfU1^�s.eia' ctl'°�vttttit; l`.i�s; � - _ . . . <br /> . t1ft13"5tlb�fA11Z�', <br /> y ..N. .NAq <br /> Y. N NA <br /> Tank 1—Contents: 9,:7Tank 3-Contents: <br /> Tank 2•-Contents: Tank 4—Contents: _ <br /> 8 Under-dispenser containment areas are free-of wat®r Ae s,and hazardous substance. Sensors are located propetly. <br /> Y. . N NA Y N I NA , <br /> Dis eraser 1/2 Dis eraser A/10 <br /> Dis eraser 3/4 Dis enso 11/12 <br /> P#2enser S/6 Dis eraser 13/14 <br /> Dis ettser 7/8 ,.. Dis eraser 15.116 <br /> PAPE )RK INSPECTION Y N NA DATE DONE <br /> 9 <br /> Monitoring system certificatiota iaasr ser}o0 leted:within 'ast 12 months, .a <br /> 10 Secondag containment tests have bopn coli► letod within the re uired timeframe. i. o a t <br /> If_ Spill containment structaireco testis ;vw, . leted within-the Rast,year. <br /> 12 Tank tightness testing was oom leted,within re u'.ed timeframe. <br /> 13 Line tightness testis• .was completed within.re uired dmef'ame. <br /> 14 1 Other re'ulred testis malptaiiance was coni lend within required timeframe, hist Iesumaintenance Items below. <br /> Test/Maintenance: *Ps s_ <br /> Test/Maintenance: 1 <br /> Test/Maintenance., <br /> -------- <br /> FACILITY EMPLOY,EE•TRAINING Y N NA . <br /> 15 AlI faeiii em to ee�have received the re aired ari-the='ob trssinin within the est year. <br /> 1.6 : Allfacility em to ees.hired within the East 30 da shave received the reqqired, n-the-'ob trainin . <br /> Note: Any tanswer of t'N"•shoutd be ekptaincd in the comment seetlon on the t'oltowing page,and will require <br /> follow-up action. <br /> Page 1 of t November 2004 <br /> STd Wd6T:20 SOOZ ZO '3a(I ObSZ T2_2 956: 'ON XtUA 30NUN31NIUW NOIld1S90Ind3S'Z'9: W08A <br />