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05/08/2008 09:30 FAX SJEH U005/005 <br /> Monthly Ins ectlon - Page 2 of 2 <br /> PAPERWORK INSPECTION Y NINA hate rkmnc <br /> Monitoring s stein certification (within pa.st 12 months) y, <br /> Spill Bucket testing eons leted within ast 12 months) <br /> 17 'ba i ••l � f ?t <br /> The above are usually dorm,logelher an an annual hao•is for local regulator. <br /> Line Tightness (usually u on construction or when no positive shutdown) <br /> lank Ti=htness (usually on1X alter constniction or when usin Sut) <br /> Sucondary containment(SB989)tests have been completed oisiiLil every 3 s) <br /> (;l her leelin s or me intenance con lele as____7. .lst t ept below: <br /> TMa <br /> est/ intenance: JC 3 t 6 <br /> `1 est/Maintenance: <br /> TcsUMaintcnance: <br /> Q'omments: �� rE-AI,"' .. . <br /> Items Requiring Follow-tiActions: <br /> Monthly inspection must be conducted by an ICC licensed Designated Operator. <br /> A copy of this checklist trust be provided to UST owner or opc`rator, but not to State Water Resources. <br /> Designated Operator must alert the UST owner or operator of any condition discovered during the <br /> monthly inspection that may require rollow-up action. <br /> I JST owner or operator inust maintain a copy of this monthly inspection and any attachments for the <br /> previous 12 months. Records must be.maintained on-site or, if approved by the local agency, off-site at <br /> a readily available location. <br />