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SiteNumber Date (,c� <br /> I tool iect o .FRI otda Mreetfix romote <br /> en x� 8In8f6.o?DeolSia. ar y xtI L <br /> TenliO SpIBHtrdatllenuf'*. lud S1. r` [1 �,�r��t7 tType 01ala <br /> :�Cglyap�i, e,;r�m. �+Y BpllT Buclut CorWlHott Bplll Baactnt(Xeon anE pry Oram 1(alvo <br /> CNI,FBW,Faifield,Franklin, bucket <br /> intact and m proper <br /> DPW.Phr7Tite,Safe Lite,Universal Estimated <br /> ecity or <br /> Is the spill bucket condition W=Water present Does drain valve <br /> Order <br /> bucket capSmgfevra0 GL Grade level direct bu <br /> per tank C-No vapor bucket,Coax system (gallons) Dkwblewalt BG=Bekry grade comments <br /> ncomments seection)the D Debris present sent funtion property[ <br /> mortfhrr D-No bucket,Diesel SW or DW NA=No bucket Yes or No CD-Clean and Dry Yes or No <br /> V=No huciret.Vapor ManrTolded NA=No Bucket NA=No Bucket NA=No Bucket Yes or No (Circle all that apply) NA=No dram valve <br /> R=No bucket,Riser <br /> only NA-No Bucket <br /> V` W F D CD <br /> 3 <br /> m <br /> �� W F D <br /> m i {V\J <br /> -�"\ W F D <br /> 42 <br /> D <br /> O 4 W F D CD <br /> rr <br /> a_ <br /> J 5 W F D CD <br /> J <br /> 6 W F D CD <br /> m 2 ` �' 5 S W F D CD }� t <br /> ,`v' <br /> 3 Imo' <br /> Is <br /> 4 W F D CD <br /> Q <br /> 5 W F D CD <br /> 6 W F D CD <br /> Spil0ackota <br /> Tank/ vWTaq Fill FiRCaps'ltiselcala! Adapt§!s..4`- Fioss�Fl�tiB!!84 .ikpfr� <br /> Product coaw/ID tag present&in Fill lid in good oond?tion&property Riser in good condition,so that it <br /> proper condition painted? Are @I caps& is safe to drop fuel? H a fdl stump IS <br /> Order gaskets in Are swivel Are delivery lose finings in present,is the riser <br /> �� adapters present? proper condition? (H not, below t)the ground? <br /> per tank PIP=Nat present NR=needs m be replaced candtion? commmenteet s sectlon <br /> monitor NC=Not in proper condition NP=needs to be painted <br /> OK=present&proper OK=good condition&painted Yes or No Yes or No Yes«No Yes or No Yes or No <br /> (Circle all[fait apply) (Circle all that apply) Unk=Unknown NA=No fill sump <br /> 7 NP NC OK NR NP OK <br /> t•- <br /> 2 NP NC OK NR NP OK <br /> U <br /> 3 NP NC OK NR NP OK <br /> U <br /> O <br /> O 4 NP NC OK NR NP OK <br /> K <br /> a <br /> 5 NP NC OK NR NP OK <br /> J <br /> LL <br /> 6 NP NC OK NR NP OK <br /> 1 NP NC OK NR NP K ow <br /> m 2 NP NC OK NR NP d K 0A <br /> f W <br /> Q� 4 NC OK NR NP OK <br /> d <br /> 5 NP NC OK NR NP OK <br /> 6 NP NC OK NR NP OK <br /> Commends on any damaged/defective equipment <br /> JUL <br /> ENVIRONMENTAL <br /> HEALTH I FFIAR.TMENT <br /> issued 12/27/2017 Page 3 of 10 <br />