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25 OCT 2005 11:52 AM FR TO 1445 P.02 <br />Designated Underground Storage Tank (UST) Operator <br />Monthlv Visual Inspection Checklist <br />Facility Name: ri-OCK-74.5 <br />MONITORING PANEL / ALARM HISTORY <br />Facility Address: 1,910 e1CC4(.i eV <br />Civ: <br />Zi Code: q_�'_2_ _C <br />.0n::0C'kf-dX4 <br />Designated UST 02ftator Conduc'N the inspection: 0 IL I V &A <br />14 &_Ae- <br />international Code Council Certification #: S-%. (a -J4 C <br />Expiration Date: 6 8'/ ;JL 7 <br />I Signature: r <br />Phone: o If ) 17:? 1 1 y:j a <br />Item <br />MONITORING PANEL / ALARM HISTORY <br />NA <br />_N <br />I <br />Monitoring system is powered on and in proper opSEk& mode. <br />x I <br />2 <br />Monitoring !Xstem is not curmtly showing any alarms or 1!3Mjags. <br />x 1 <br />3 <br />All= history report/log for the previous month is available, and has been reviewed by the <br />Designated UST Operator. Attach a copy o q t bmt fL available. <br />f the alarm history report/log I d is ay b <br />4 <br />Each alarm for the Ucvious month has been responded to telx - <br />5 <br />Sensors located in tank- containment sumps have not alarmed in the E91 month. <br />5a <br />List all tank -top sumps where alarms occumed in the past month: <br />Note! sumps whom an alarm has occurred w the past mach must be inspected mien a quaViedseroice technician responded m and <br />properly addressed the cause offt alarm. Atwh doftmenrw)om verifying appropriate service 10 this rapare. <br />the irect,record resuirs in tram 6, below. <br />_!4r7!i <br />UST SYSTEM INSPECTION <br />6 <br />Tank -top containment sumps are free of water, debris, and hazardous substance. Sensors are located properly. <br />-10-Nak: eauat t5az afam occurred he a moyghfar W is no nervier deard <br />afar xx !2k2!SMM91N J!M re an alarm has 0 to t which there se ke r <br />Y I N <br />Y P1 <br />SuMpLocadon.. IR144A- A~X <br />Sump Location: <br />_ <br />Stas <br />p Location: <br />Sump Locadan: <br />SHME Location: <br />7 <br />S2iH containment structures are free of water debris. and hazardous substance. <br />Y I N I N <br />YJ N I NA <br />Tank I - Contents; ftA_ j Tank 3 - Coments: <br />Tank 2 - Contents. Tank 4 - Contents; <br />$ <br />Under -din penw containment areas are free of water, debris, and hazardous substance. Sensors are located.Properly. <br />Y IN INA <br />Y N NA <br />Drs penser T/ 2 '-Z I Dispenser 9110 <br />Dis ser 5 4 Dis ser 11112 <br />Dimenser 5 6 2i1�enser 13 14 <br />Dispenser 7 8 D!sLenser 15 16 <br />J' <br />PAPERWORK INSPECTION Y N I NA <br />I DATE DONE <br />9 <br />Monitoring system certification has been completed within gjg 12 months. <br />0 0 <br />10 <br />Secondary containment tests have been cam leted within the Munrd tunelmmo. <br />b 0< <br />11 <br />struc ) testina was completed within The past year. x <br />Spill containment tare ticket <br />i o 6'a 0' <br />12 <br />Tank tighutess testing was completed within E2q!Lued timeframe. ............ .. . x <br />-STC? <br />13 <br />. . <br />Line ' ta res to;was _ completed within required timeframe. <br />—10 —I'- <br />14 <br />Other required test rWmaintenance was completed within required timeframe. (List test/maintenance items below.) <br />TestVdinrenance:tA -h A L, <br />TeivMaintenance: k., <br />1 lot <br />Test/Maintenance: <br />FACILfff EMPLOYEE TRAINING <br />Y N NA <br />15 <br />1 All facility em la have received the E.TMEEd on-theob train= willijui the pLA year. <br />16 <br />1 All facility emDloyecshired within the past 30 days have received the required on-th&Job training. <br />Note. Any answer of ON" should be explained in the comment section on the following page, and will require <br />follow-up action. <br />Page I of 2 November 2004 <br />