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Designated Underground Storage Tank (UST) plerator <br /> Monthly Visual Inspection Checklist <br /> rrcilitc Nafa <br /> Date: <br /> FWjIjtX Address: <br /> i Colo: ---.'----_ <br /> O <br /> Dari ted US O rota,Con un the[ns tion �"--- <br /> International Code Council C fican d ' Br nation Date: <br /> si rare: _ Photic - <br /> Y_p � n. r <br /> Ilteml NG PANEL/ALARM HISTORY N_ NA <br /> I Moniton system is powered on and in r operating mode. <br /> 2 Moni[cxin system is not currently showing any alarms or warm n s. <br /> 3 Alarm hist,,-,reps vlog for the Previous month is available,and has been reviewed by the <br /> DesienatxxJ UST rotor. Anoch a ca o the alarm history re orl/lo ro this arm i ayai/aB(e, <br /> 4 Each alarm for the revious month has been res tided to a ro riatel . <br /> 5 Sensors located in tank containment sumps have not alarmed in the month. <br /> S - list all rant-lop sumps where alarms occurred in the part month: r,L^F;I,l H I STOR'f REPURJ <br /> ----- SENSOR fit_F+FI - <br /> Na,..9mps where an alarm has mw7edin rhepasl month mart be impectedunleu L ':91 STP SUMP <br /> properivaddreved Mecmcuafdwalarm.Aaarhalixmtenmtion wrffyingyyraprlale dthIs rerechrdrran STP SUMP <br /> ti,.ar recardrewar in item 6,below. to lhir repo". <br /> FUEL ALARM <br /> OCT 2, 2012 1:^_9 pl, <br /> UST SYSTEM INSPECTION SENSOR OUT wLARr1 <br /> 6 ank-top containment sumps are free of water,debris,and bazardous substance. SensorsareloeatedFEB 27. 2012 10:14 AM <br /> . ore:yta(Ntion bonny <br /> Y 'N <br /> in when an almm hat mEw'redrn the tmaiah which is. FUEL ALwRI9 <br /> Sum Location: Stun Location: FEB 27. 9:49 nM <br /> Sum Location: Sum Location: <br /> S Location. Sum Location: <br /> 7 S 11 containment structures are rmeof water,debris,and hazardous substance, <br /> Y N NA <br /> Tank]-Contents: <br /> Tank Tank3-Contents: <br /> L< <br /> 2-C°"teArs. ,�. ,.`^- Tank 4-Contents: <br /> 8 Underdi riser oon "amen areas are free of Water,debris,and hazardous substance. Sensors are lova <br /> Ors rarer]/2 <br /> Y /N NA . ENL. . . . . . <br /> y <br /> Dis mer3/4 Dis user 9/70 <br /> Dis -"5/6 Dis rarer 11/72 <br /> Dis user 7/8 Dis enter 73/74 <br /> Dispenser 75/76 <br /> PAPERWORK INSPECTION NA <br /> Y �'N <br /> Moratoria s•stem certification has been <br /> 1 g cont feted within t 12 months. <br /> COaamet tests have been cont feted within the aired timeframe. gLARM NISTOR`[ REpORT <br /> S If containment strucuue bucket [estin was corn lewd within the [ ear. - SENSOR HLtkW ----- <br /> Tank u mess testin was cont feted within r aired timeframe. 9l F lLL SUMP <br /> Line tr mess testin w L 7 <br /> Otherr aired testi¢ �� elect withinr uired timeframe. PIPING SLt'1v <br /> maintenanceiv scont FEB ,j7ILAWL,2 :t <br /> I7 Pit <br /> lest/Maintenance: feted within r uired timefnune. 71st iest/maintetuurc <br /> Test/Maintenance: <br /> Tett/Mainte FE17 OUT tiLHa t t 4 Art <br /> Hance: FE13 H "Ot� l0' <br /> All fau cility .vees, FACILITY EMPLOYE(;TRAINING FUEL ALARM 5a .N'. <br /> •> 9: <br /> Alaraern lu 'ave receival the r mired Un the rob training within the past year. FEB 27. <br /> ee'a lu M <br /> Any anrwer o/"N"ab '�in the t 30 de s have received the r uired on-the-'ob tmiiinw, <br /> rollow-up aeu.. °raid�'exPialned to the comment section on the following page,and will nvluir <br /> 61W"M .M M rn <br /> S <br /> AW <br /> r Yry 7 <br />