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M <br /> �— O <br /> ti <br /> � - N <br /> N <br /> N N <br /> o v DESIG <br /> UNDER OG RUND STORAGE TANK (UST) OPERATC�t <br /> o <br /> MONTHLY VISUAL INSPECTION_ CHECKLIST <br /> Quik Stop Market#138 <br /> mss 1953 Lincoln Blvd, Date January f <br /> L <br /> p 95376 <br /> U told <br /> N Largo <br /> ry 293993 <br /> Expiration November 4,2018 <br /> 916 373-1186 <br /> Item MONITORING PR <br /> 1 monitoring system i5 n p Mold_ --.: <br /> 9 ys powered on and in proper operating mode <br /> 2 Monitoring system is NOT currently snow ng any alarms or war =rys. ■ <br /> — - ■ ❑ <br /> 3 Atarmftrstory report/log for the previous month is available,and has been reviewed by the Designated UST Operator ■ <br /> 3a is a p pyof the alarm history report j ❑ <br /> _. __ tog to this form? <br /> 4 Each Warm hrr,the previous month has been responded to appropriately. ■ ❑ <br /> 5 Sensors located in tank top corttaurrttent sumps have NOT alarmed in the past m <br /> an -tvp''conta9nm�nt sumps are free of water,debris,and hazardous substance_ Sensors are located props <br /> Note Vrsua/rnspechon Of is only ., <br /> _ Y requrred in sumps where an alarm has occurred;n the,oast month for whrch there isno Service record <br /> � Y N � <br /> -- <br /> Sump Location: Y <br /> ❑ ❑ Sump Location ❑,9 } <br /> — ump Location ❑ <br /> ElSump Location: <br /> � ump Location: ❑°s <br /> ill Containment Structures are free of water,debris,and❑ ❑ <br /> hazardous su <br /> VTa Y N NA <br /> ■ ❑ ❑ <br /> n Tank3 91 <br /> � Ta � <br /> ■ <br /> Under El El <br /> dispetx er n ent areas are free of water,debris,and hazardous substance. Sensors are located pro <br /> cC <br /> Y N NA f <br /> k <br /> PAPERWORK INSPECTION <br /> Monitoring system certification has been completed within the past 12 months. <br /> Secondary containment tests have been completed within the required timefra <br /> Q Spilt containment structure(bucket)testingwas com � $�� � <br /> V _ pleted within <br /> Tank tightness testing was completed within the required timefr <br /> } o Line bghttless testing was completed within the required timefra ❑ <br /> _._. <br /> tar ter{idled testing/maintenance was completedEl <br /> Q . t <br /> 0O Testi Maintenance Air Duality Test - -: <br /> ` 9117 ■,x <br /> U) <br /> � o = <br /> J W <br /> m � O <br /> Z V <br /> J O <br /> O n <br /> Z0011- 'C3 Y <br /> O N <br /> i O O m <br /> 00 Lo N <br /> co O C�j <br /> V- , 2 :3 <br /> IL N <br />