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05/02/2008 09:43 FAX SJEH 0005/005 <br /> Monthly Illy", wetion - Pagt 2 or 2 <br /> WRZ2 ,I�% $ <br /> o. <br /> PAPERWORK INSPECTION Y N N - Date Done_ <br /> Monitoring systetri certilicatiorl.(within past 12 months) <br /> Spill Bucket test'ng colli Meted (within 12,1SI. l2 U10111110 3. <br /> osts'tcs ( ithinpas jj()tITI17S) <br /> t 121 <br /> Tht!fj1)e)jIe JI/C d017e lcpgc,flu�r on an annflat bavis for locol 0-ogulator <br /> Llrjeli�'Iitness (LI'AR111Y 1.1 on rowistniction or when i10 2()f;itiVC shutdown) <br /> Tink Tightness (usually urily aner mistructLon or When U:3I*.JIkISIR) <br /> 2Z 6 <br /> . :12aqII—Iry-CC tairimcrit S1 989 tests have hem completed(usually eve 3.yr.-;) <br /> —T)T,I;'-,,r lestiny or Iiiiaintenance c them beto wl: <br /> L/Mitintunmicu: <br /> -SUMainteivinae: <br /> -t/Maintenance: <br /> C4. aments: <br /> _I«•.ns Requiring Follow-up Actions: <br /> Monthly inspection inust be conducted by an ICC licensed Designated Operator. <br /> A copy or this checklist must be provided to I)STowrier or operator, but not to State Water Resources. <br /> Designated Operator must alert the UST owner or operator of any condition discovered during the <br /> m6irthly inspection that mulify' require JbIlow-up actf&ii— <br /> I)STowner or operator naust 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 />