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UNDERGROUND STORAGE TANK SYSTEM <br />DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT <br />Facility Addres <br />s: 1930 <br />in, VMMMMI <br />Expiration Date: 12/23/2011 <br />AW, MAL 110111 1111111111 qllliiiiij� <br />rt e—m — MONITORING PANEL/ ALARM HISTORY Yes[_No N/A <br />1. Is the monitoring system powered on and in EolLer o rating mode? fs IR El <br />2. Is the system not currently showing any leak alarms? x <br />3. Is the Alarm History Report/log for the previous month available, and has it been reviewed by the Dd I E] = <br />, Designated UST 01?2ratoO (Attach a copy of the alarm histo LgE2Lt11o& to this ins pectionform.) <br />4. 1 Has each alarm for the previous month been resp9nded. to appropriately? <br />UST SYSTEM INSPECTION <br />5. Are tank -top containment sumps free of water, debris, and hazardous substance? Note: If the answer to Item 4 was "Yes, " skip <br />to Item 6 Sumps where an alarm has occurred in the past month must be inspected if a qualified service technician has not responded to, and <br />ERWORK PTION <br />PAP-WSEC i . =- <br />ry. 19 11 �,�MFJ INFLA <br />Sump Location: <br />Location: <br />Sump Location: <br />rMIM.11MIRIT-rimplu M. <br />r R-1 rMTV, <br />_Siump <br />WIFMI <br />V IN -M. rt P l."L 11. 1 <br />f =,-too MT <br />Yes No <br />N/A <br />=—Describe <br />11011011102 <br />Tank 5 ID - <br />INAIM <br />j11 <br />—FACILITY EMPLOYEE TRAINING <br />W.T=t a I t <br />man <br />1-1-64 "N 1"W <br />Dispenser - 3/4 <br />NO <br />V <br />i Di ser - 5/6 IOU", <br />Dispenser - 13/14 <br />MUTT <br />located within unde <br />Leak detection is properl r-dis <br />nser containm ent. <br />_y <br />In <br />Of <br />Dispenser - 3/4 <br />Ms /12 <br />�enser - I I <br />Mani <br />5/6 <br />-3 <br />I DiWnser - 7/8 <br />OW "a <br />ERWORK PTION <br />PAP-WSEC i . =- <br />ry. 19 11 �,�MFJ INFLA <br />rMIM.11MIRIT-rimplu M. <br />r R-1 rMTV, <br />V IN -M. rt P l."L 11. 1 <br />f =,-too MT <br />=—Describe <br />Test/maintenance: <br />—FACILITY EMPLOYEE TRAINING <br />MINIMUM- =-.1 <br />