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r1 <br />This inspection checklist must be completed each month and maintained on site for a period of 3 years. <br />Any item receiving a "Yes" response must be corrected immediately. Details of the deficiency and <br />corrective actions taken must be fully described on the bottom of this checklist. <br />Site Code: Address: <br />Tanks ID No(s): <br />Y NNA Deficient Tank ID <br />Diesel Fuel Storage <br />Fill or Monitoring Port covers and caps are not property <br />sealed or locked to event leaks and unauthorized ent <br />Spill Bucket is broken or deteriorated <br />Spill Bucket contains fuel, water or debris <br />Spill Bucket Bucket drain mechanism is non-functional <br />m <br />Piping Sump cover is damaged or non-functional <br />Overfill Limiter and/or Overfill enunciator is non-functional <br />Fuel Piping <br />Fuel line rubber boots are cracked or deteriorated <br />Pipe fittings are rusted, cracked, swollen or leaking <br />------------ <br />Flex connectors are leaking or deteriorated <br />Piping supports are damaged or deteriorated <br />� <br />Pipe sump(manway) contains water, fuel, or debris <br />Automatic Tank Gauging (ATG) System — Fuel Monitoring <br />ATG System is not fully functioning properly <br />Hi Fuel/ Low Fuel/ Water in Fuel sensors in Alarm mode <br />ATG alarms not connected to Network Surveillance <br />ATG printer is non-functional or out of printer paper <br />ATG monthly "Leak Detection Test" not being performed <br />Diesel Fuel <br />Fuel degradation is suspected as evidence by clogged <br />filters or dilikwlt engine startu <br />Response Equipment <br />Spill response equipment inventory is missing or depleted <br />-------------------------------------- ----- <br />Record Keeping <br />UST registration certificate is not current or posted <br />Monthly "Leak Detection Test"printouts are not available <br />for most recent 12 -month period <br />Describe deficiencies and corrective actions on the back of this checklist. <br />Inspector Name: Title: <br />Signature: <br />Form Date: 5-I0-07 <br />Lim <br />