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' Desiggated''Underground,Storage Tank (UST) Operator <br /> Monthly Visuat'Inspection Checklist' . <br /> Facility NAnic:.'e , Dat <br /> ®.. _! L„] r e; ( R <br /> Licsf,gnated t I§'r 014rator Condgtitag the Ins .ection: ak,. i G <br /> International Coqe Council Certification'# ,Y2 x ire ion Date: / 1 <br /> si store: _ Phone: 4 7! 2 <br /> Y M Yea N-No NA=NotAvolicabic <br /> Item MpI TWO PANEL%ALARM WSTORY I Y I.N I NA <br /> I Monitorin s stem.i&' owcre on awfln. Pie�ratiRmode, . <br /> 2 Monitolrin system is not current .s. !no any:alarms or warnin <br /> 3 Alarm history report/log for the previous tnbnth:is available,and has been reviewed by the <br /> Desi ated UST.4•orator, 4f adh a t o •o the al histo 're orNlo to this orrdt'i available. <br /> Each alarm for-the pr6vious month has beeti responded to apptoprigel . <br /> Ssensors located in.tank=to .con ffiment sum s havomot alarmed in the past month. <br /> 5a List all tank-top sumps where alarms occurred.rn the past month. . <br /> Note;Sumps where an alarm has occurred in the past month moat be lnspeeka!unless a qual/fted service teehnietan responded to,and <br /> properly addrs aced,the carate of the alarm,%l oath documen0don verifying appropriate service to this report. <br /> sum ins fffm 11 re dlrid record results in-Item 6 below. <br /> a ST SYSTEM INSPECTION <br /> 6 Tank-top containment sumpsia'c Pee,ofvlalei,debris,arra hazardous substance. Sensors are located properly. <br /> Ote.Ytsual tnSyectlon•gf Bumps Is.otired4n.4ta mAI where an alarm has occurred In the est month or which there Iso service record <br /> Y N Y N <br /> Z <br /> nrrrtion. _._.:........ _ Sum Location: <br /> nc:rrtirrn; <br /> ..� . Sum Location; _�..... m <br /> __7itainrilerfis4z�cf.�ar01TP4•.0eV. 6r,-d4,H ;.tnd;laawduus•4ubmii-0G,_YN NA Y N NA <br /> Tank I -Contents: Tank 3•-Contants: <br /> Tank 2-Contents: Tar1k.4—Contents: <br /> 8 1 Under-dis sneer containment pGeas era froe"of water`debris and hazardous substance, Sensors,are located ro etl . <br /> Y'. N ':1VA Y I'NA. <br /> N <br /> Dis eicaer 1/2 Dts enser 9/10 pC <br /> Dis enser 3/4 Dls Cesar I1/12 <br /> Dls eraser S/6 ,ills enser 13/14 <br /> Dis elver 718D", 5•/16 <br /> 11 11111 <br /> PAPERWORK INSPECTION Y • N. NA DATE DONE <br /> 9 Monitoein s storm certifica iorl•h beett- tetedmithin tast 12 months. tU-Cily <br /> 10 Secorldary,cont4lnrnent testi have been nom Ieteld within tharequired timeframe. <br /> 1 I Spill containment struo ,gqket.f0n .W.' eo iotas within�the ast' ear. _a <br /> 12 snit ti tress testin was Go leled.within required timeframe. . <br /> 13' Line tightness testin .was completed within re •uired tirnetrame. <br /> 14 Other requfred.testin maintenance was cont leted'vdthfn required timeframe. List tesilmaintenanca items below. <br /> '/'eyt/Maintenanre: <br /> TesbtMaintenance: -' <br /> I jul 11 11, 111111111121 <br /> FACILITYEMPLOYERTItAINING Y N NA <br /> 15 All f•g I <3IT�oxces have received there uired orf-the='ob�trainin within the ast ear. <br /> tbAll tacitit eirr to ees.hired within the gwt 30 da shave received the r i ired on-the- ob trainin . E 1 <br /> Note: Any answer of"N"stibuld be eiplainod in the comment sedidn on the following page,and will require <br /> follow-up action, <br /> ?*je i oft <br /> November 2004 <br /> TZd WdZZ:20 900Z ZO '0aQ 0 V9 U-2 9Z 6: 'ON Xtid BONUN31NIUW NOI1ti1S90In83S-Z'S: W0NJ <br />