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I W/O#: 1 150310�404 <br />UNBURIED FUEL PIPING INSPECTION § 25281.5 <br />17 <br />I <br />Unburied fuel piping, g!gnU, and containment are free of water, leaks, and hazardous substance. Sensors are located properly. <br />Y N I NA NOTES use comments below If more room Is needed) <br />all unburied piping✓ <br />Comments: <br />Items Requiring Follow -Up Actions: <br />9 <br />ENVIMNMENTAI <br />HEALTH DEPARTMENT <br />Instructions: <br />Monthly visual inspection of the UST system must be conducted by Designated UST Operator, who <br />possesses current, California UST System Operator- certification issued by the International Code <br />Council. <br />A copy of this monthly visual inspection checklist must be provided to the UST Owner or Operator, but <br />not to the State Water Resources Control Board. <br />The Designated UST Operator must alert the UST Owner or Operator of any condition discovered during <br />the monthly visual inspection that may require follow-up actions. <br />The UST Owner or Operator must maintain a copy of this monthly visual inspection checklist and all <br />attachments for the previous 12 months. The records must be maintained on-site or. if approved by the <br />local agency, off-site at readily available location. <br />Page 2 of 2 November 2004 <br />