COMPLIANCE INFO_2008-2018 - Laserfiche WebLink

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Anthly Inspection This inspection checklist must be completed each month and maintained on site for a period of 3 years. Any item receiving a "Yes" response must be corrected immediately. Details of the deficiency and corrective actions taken must be fully described on the bottom of this checklist. Site Code: Address: Tanks ID No(s): Y N NA Deficient Tank ID Diesel Fuel Storage Fill or Monitoring Port covers and caps are not properly sealed or locked to prevent leaks and unauthorized entry Spill Bucket is broken or deteriorated Spill Bucket contains fuel, water or debris Spill Bucket drain mechanism is non-functional Piping Sump cover is damaged or non-functional Overfill Limiter and/or Overfill enunciator is non-functional Fuel Piping Fuel line rubber boots are cracked or deteriorated Pipe fittings are rusted, cracked, swollen or leaking Flex connectors are leaking or deteriorated Piping supports are damaged or deteriorated Pipe sump(manway) contains water, fuel, or debris Automatic Tank Gauging (ATG) System — Fuel Monitoring ATG System is not fully functioning properly Hi Fuel / Low Fuel / Water in Fuel sensors in Alarm mode ATG alarms not connected to Network Surveillance ATG printer is non-functional or out of printer paper ATG monthly "Leak Detection Test' not being performed Diesel Fuel Fuel degradation is suspected as evidence by clogged filters or difficult engine startup Response Equipment Spill response equipment inventory is missing or depleted Record Keeping UST registration certificate is not current or posted Monthly "Leak Detection Test' printouts are not available for most recent 12 -month period Describe deficiencies and corrective actions on the back of this checklist. Inspector Name: Signature: Form Date: 5-10-07 Title: Date: