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S' 1 <br /> f: <br /> 1 <br /> - I <br /> Designated Underground Storage Tank NST) Operator <br /> nthly Visual Inspection Checklist <br /> D <br /> a _ <br /> .ddrats: Zi Code: <br /> iration Date: <br /> n&I Code Cotmeil Can6 Phone. s <br /> Y-Yee,N-NILNA—NM Am <br /> M RIN PANEL/ALARM <br /> HISTORY Y <br /> t <br /> nit stem is coved on and in o ratin mode. <br /> niton systernmoot0lrrend showing an•alarms or varninils. <br /> Vol history mporviog for the pret•iow month is available,and has been reviewed by the <br /> s- ted 175T tor. Atraoh a m of the alarm histo re rt90 m this orm i auatlable. <br /> ch alarm for the om month has been rwPonded w° ro lintel <br /> riots located in tesik-to2cOnt"flnientsunaPs have nW alarmed in the 1p.t month. <br /> List all rmrt-oPs Ps wherealamv ooetrrrrdM the Past month: <br /> f ar,Suaya rhr"on dna,haomv,edat d pat,m,wh mart br,mjwadunk"ap,,hfiedurom reehWeimmspade'dto,and <br /> 1 prgrrA adbured de omae of a abet Aauh domes Uafion rrn;f irlC nPPtblt^me eenau b thb"part <br /> y f7mnp aapema+u"q,uxd"rad xsdtr le ranw Q brow. _ __ _ _ <br /> UST SYST&M INSPECTION <br /> nk-top containment sumps are free of water,debris,and banrdous substance. Sensors are located ptoparlY. <br /> �'orr: [Lad,m dron o u o,rh (n whrm an damn her ocnarrd m the ptiw.thLoL.hirl them is noserok,ma <br /> Y JIN Y I N <br /> tion: Sum Location: <br /> vocation: - Sum Location: <br /> Lacatioe: .e Sum Location: € <br /> all containment structums are ee of water debris amt hazardous substance. <br /> Y N NA y t END - <br /> nk I —Contents: Tank 3—Contents: <br /> rA 2—Comerru: Tank 4—Contents: <br /> rder-0i contiinmentareas are free of water,debris and hazardous substance. Sensors are located <br /> Y N NA Y <br /> s user 111 Dispenser 9110 <br /> s nmr314 Dispenser 11/11 <br /> ipenser 5/6 Dispenser 13/14 <br /> 11fCr 7/8 Dir err 15/16 <br /> PAPERWORK INSPECTION Y 7' N NA DA ;LrkRrl HISTORY REF'OR? <br /> Omtorulg s stem certification has been completed within past 12 months. SENSOR riLt:Rti <br /> zoa -containment tests have been completed within the required timeframe. 1 ; <br /> till containment structure bucket testingwas completed within the t Year. t OTHER SENSORS <br /> ink ti fitness rest,112B was Completed within required timeframe <br /> me ti tress wstMA was con feted within required timeframe. <br /> cher r cued testis maintenance was completed within required timeframe. Ost test/maintenance items <br /> Test Marntenanee: <br /> eat?Saintenance: <br /> mn(enancr <br /> FAC'ILI'TY'EMPLOYEE TRAINING Y N <br /> 11 adli em I eras have received the r uuad on-the-'ob training within the t ear. <br /> Aal it within t 30 s have received ther We=uired on- o train' <br /> ',Rad' a r �' <br />