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Designated-.Underground,.Storage Tank (UST) Operator <br /> Monthly Vista l` a6pection Checklist . <br /> lyacili Nam®:. Date; 2. , <br /> Zip Cod® <br /> llesignated. S'i'Operator Conductingtherinspeetion <br /> International ®de Co 'oiloii CertificAtiori# , •Ex ire ion Date; -T/ -5 <br /> Phone• n7 ) -'_ . <br /> Y=Y N=No, WNotlivable <br /> Item M0M ORI1KG PANEL;ALARM HISTORY Y .N NA <br /> HIM <br /> 1 Mon{torin s stem-is owert$ oriMfln,py4per9p ing made, - <br /> 2 Monitoring system is not currently.,showins alarms or warnings, <br /> 3 Alarm history report/log for the previous•mbnth is available,and has been reviewod by the <br /> Designated UST 220mtof, Attach a CO a the altYrm htSdO 7 ort/lo to this orm, 't available. <br /> 4 Each alarm for the Rrtviaus month has been responded to a ro riatel . <br /> 5 Sensors located in tank-top containment sums hamnot alarmed ui the past month, <br /> 5a List all tank-top suints where alarms Qccurredln the past month. <br /> Note:Sumps where an alarm has occwred.tn flee past makth must be lnepeated unless a qualoUd servlee technician responded to,and <br /> properly addressed,the eatw of the alarm.xnach doctmrentodan ver&'Ing appraprtata service to this report. <br /> Itsump ins Brion 1i tilred,r8eatd results!n.ltem 4,below. <br /> E_ U #'SYSTEM{IN PECTION <br /> b Tank-top conte nmeni suif►ps'erd flee-df"•Wd*,debtis,and hazardous substance. 'Sensors are located properly. <br /> ote:Visual ins eatlon sum s fs onT r u/red nourn s where an alarm has occurred In the est month or which there is m•service record. <br /> Y. -N —W_ Y I N <br /> 1um Location: SumLoczttion: <br /> Sump.Location, Fymp Location: <br /> .Sum Location: Yump,Locallotr: <br /> S"311.s��tit�ii5i?zec.-strd _:res`_. : .z:� � +s it ;'ai»t€;tFia subsiiid :.. _ .. <br /> Y _N 'NA I Y N NA <br /> Tank 1–Contents: aL Tank 3 Contents: P <br /> Tank 2–Conlehis: l t - Tank 4 Contents: <br /> 8 Under-die anser containment areas are frae'Of vVator ebris,and hazardous substance, Sensors.arh toe ted properly., <br /> Y . N 'NA Y N NA <br /> DTs anser 1/Z Das eraser 9!10 <br /> Ars anser 3/4 Dls anser 11/12 s'' <br /> Dls anser S/6 DTs anser 13/14 <br /> DTs en*er 7/8 DTs anser 15.116 <br /> PAPERW-0RK INSPECTWN Y N. NA ATE DONE <br /> 9 Mon{torin yAertt ast 12 months. t'• t _J,.. <br /> 10 Secondary containment tests have bQen eons let6d within the re•uined timeframe, --• <br /> I I Spill containment structureqo'et)-.fcs ' completed within-the pastcar. <br /> 12 'Tank ti tncss testing was qom leted..within r•6 uired timefiarna. <br /> 13 Line tightness testin .was eQm letcd within r Ired timeframe, <br /> 14 Other re 'uired testin mairltehdnee Was coria li ted within re uired timeframe, List testlmaintenanee items below. <br /> Test/Maintenance., <br /> 7'9flUaintenance <br /> Yest/Maintehance: <br /> PACILITY EMPLOYBE•TRAINING Y N_j NA <br /> 15 All facil{ em to ees have received the r uired on-the=ab brainin within the est ear, <br /> lh : A11 acili em to ees.hired within the ast 30 da shave received the ro uired on-Rha-'ob trainin <br /> Note: Any answer of"N00 sliould be explained in the comment se0on on the following page,and will require <br /> follow-up action, <br /> ''P'&'ge 1 of 2 November 2004 <br /> LTd WdOZ:20 S00Z Z0 'oa(I ObSZ ZZ2 9T6: 'ON Xdd 30NdN91NIdW NOI1d1S30I0N3S'Z'H: WONJ <br />