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1T_ <br />Awk <br />Designated Underground Storage Tank (UST) Oprerator6co78o13 <br />Monthly Visual Inspection Checklist <br />1' acility Name e.,.,.i.a__ • _ _ .�,., <br />Y=Yea, N=No, NA=Not Applicable <br />Monitoring Panel / Alarm History Z, N <br />NA <br />tutorinI system is powered on and in proper operating mode. <br />aitoring system is not currently showing any alarms or. warnings <br />rm toryrepo og ort a previous mon �s av a e, an s been reviewe y t e <br />ignated UST Operator.(Attach a copy of the alarm history report/dog to this form if available.) <br />h alarm for the previous month has been responded to appropriately <br />lora located in tank -top containment sumps have not alarmed in the past month <br />all tank -top sumps where alarms occurred in the past month: <br />Sumps <br />an <br />of the alarm Attached ldocument­*_.­--- <br />i cum ne to * ed ut repast month must be inspected unless a qualified service technician responded to, and properly addressed, the <br />y ng appropriate service to the rennrt 7F sa e <br />P containment sumps are free of water, debris, and hazardous substance. Sensors are located properly. <br />of sumps is only required in sumps where an alarm has occurred in the past month for which there is no service record. Note Visual <br />I' N <br />�rnfiinn. _ V TIT <br />I containment structures are free of water, debris,®and hazardous substance <br />Y N NA <br />1 -Contents <br />2 -Contents <br />Tank 3 - <br />Contents <br />r -dispenser containmentareas are <br />Tank 4 - Contents <br />free of water, debris, and hazardous substance. Sensors are <br />N NA <br />enser 1 /4 <br />2iY <br />?user 3/4 <br />Dispenser 9/10 <br />>nser 5/6 <br />Dispenser 11/12 <br />tnser 7/8 <br />Dispenser 13/14 <br />Dispenser 15/16 <br />y Monitoring syLt <br />rtification has been completed in the past 12 months. 1V <br />10 Secondary connt tests have been completed within the required time <br />ic <br />11 Spill Containucture (bucket) testing was completed in the last year <br />12 Tank Tightnesg was completed within the required time frame <br />13 Line tightnesswas completed within the required time frame <br />14 Other required testing/maintenance was completed within the required time frame. (list test/maintenance items <br />Test /Main.tpnanro • <br />- -- y IN <br />IMLAH Facility employees have received the required on-the-job training within the past year. <br />16 All facility employees hired within the past 30 days have received on-the-job training <br />Note: Any Answer of w, should be explained in the comment section on the following page, and will require follow-up action. <br />