Laserfiche WebLink
UNDERGROUND STORAGE 'WANK SYSTEM <br /> DESIGNATED I TST OPERATOR MQNTIE LY INSPECTION REPORT <br /> Facility Name: Inspection Date: Q <br /> Facility Address: rr City: (fA . <br /> Name of Designated UST Operator Conducting Inspection: LLQ t( <br /> International Code Co ii Certification No.: Ex cation Date: q <br /> J���4a67La " SSC. p <br /> Signa hone: o b, <br /> N/A-Not A plimble <br /> FItem MONITORING PANEL/ALARM HISTORY Yes No N/A <br /> 1. Is the onitorin stem powered on and in roer o ratin mode? <br /> 2. Is the monitoringm not current! showinganleak alarms? LJ DIE] <br /> 3. Is the Alarm History Report/log for the previous month available,and has it been reviewed by the <br /> Desi ted UST tor? Attach a copy o the a1arnt hisimy Morv7o io this ins ction orm. <br /> 4. Has each alarm for the grevious month been ded to appropriate! ? El Ell El <br /> UST SYSTEM INSPECTION <br /> 5- Are tank-top containment sumps free of water,debris,and hazardous substance? Note:Ilehe answer to Item 4 was "1'cs,"skip <br /> to kern 6.Sumps when an alarm hat occwred in the past month must be inspected ija quaked service technician has not responded <br /> ro addressedrhe cause o the alarm.Documentation ve�i i trate service should be attached to this report. <br /> Yes I N Yes o <br /> Sump Location: Sump Location: <br /> Su Location: _- Elio Sump Location: 10 <br /> 6. Arcs ill buckets(containm structures)free of water,debris and hazardous subs <br /> Yes No N/A I Yes No N!A <br /> T:,,d-, <br /> - Tank 4 ID- ---' <br /> T - Tank-S415-- <br /> 3 -- k 6 ID- <br /> Adi nser containment areas free of water,d ris,and hazardous substance? _ <br /> Ye No N/A o N/A <br /> DDi ser- 4D - Di enser- <br /> D - --- �fffl <br /> Dispenser--1 Li J16 <br /> - <br /> Dis ser- Di -user- <br /> &. Leak detection is prolocated within und -dispenser containment. <br /> Y No I N/A Yesj No I N/A <br /> Dispenser-litr K& Dispenser- U 10 1 El <br /> Di ser- Dispenser- 5 <br /> Di nser- Dis ser- <br /> Dis ser-- Dis ser- <br /> PAPERWORK INSPECTION Yes No NIA Date Done <br /> 9. Monitorin System Certification was corn feted within the past 12 months? <br /> 10. Line Leak Detectors were tested/certificd within the past I2 months? <br /> 11. Spill bucket containment structure tWing completed within the past 12 months? _ <br /> 12. Line_tightness testing completed within therequired time frame? <br /> 13. Secondary containment tests completed within the r uired time frame? <br /> 14. Enhanced Leak Detection completed within the requirrd time frame? <br /> IS. Other regWred testis maintenance was completed within required time frame. esthmaintenance items below. <br /> Describe Test/Maintenance: <br /> Describe Test/Maintenance: <br /> FACILITY EMPLOYEE T G Yes No NIA <br /> 16. Have all facilityemployees received the uired on-the trainin within the est .ear? <br /> 1 7j Have all facility employees hired within the East 3 a s received the required on-the-job training.? <br /> Note: Explain any"No"answers in th��www.nntdocs.org <br /> ction on the following page.Those issues require corrective action from <br /> the UST owner/operator. <br /> UN-057-112 9/26105 <br />