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2010-09-15 15:39 Costco #1031 2098258204 >> 2094683433 P 13/17 <br />0 0 <br />Desigilated Underground Storage Tic (UST) Operator <br />onffily Visual Inspection Checklist <br />�tC731 <br />I <br />Z <br />Facili , Name: r. -coo { t Date: <br />Facility Address: x,41 S - _ <br />City: 4e , Zi Code:`i`53�4� <br />lDesi at4d UST Q gator ConductizjR the In ectiori. <br />Internmiomd (Lde C uracil Certification #: 3 G,. s Ex iration Bate: i 4.. /11 <br />Signature: Phnns. f �ltG 1 t] �?dam <br />�tC731 <br />I <br />Z <br />1.= NCR, iv = ,'No, NA = Not Applicable <br />i%,IONITDRING PAPEL i ALAR . MSTORY # ttt <br />Montoro,- s •stens is otivered on and in or cr o eratin movie. ,� <br />11%toiiita 8t R1 Is pia$ currents showin any alarms or).varnings. x <br />Alarm history report/log for the Previous month is available, and has been reviewed br, the <br />x <br />Designated UST 2perator. (Attach a copy of the [Ilam histot repollLIOZ to rIjjS t7YNt t a-,,a,EIftbkj <br />=i <br />Each alarm for the pLevious rnonth has been responded to a ro riately. <br />5 <br />Sensors located in tank-toR containment sip s Have not alarmed in the past month. <br />- List all took -top stfrups %vhere Utc,p-nis occurred in the past Bondi: c� <br />-ALA.. <br />V'cte: Stapp wharz an ivann J= Occurred In tha P=(month nmcst'be inspected unizss a qualified service technician rap anded to, and <br />-0=414,, <br />jrrorarh't WP the collie gftlmdann.. fracfTC�f7if27787NA77O17 tel -61 T8 G#pproprFalf,service to 070 'e_DO17. <br />t, SU7ikJ1 1 C1C(jGiR is rE` !L°Cl, f'rCO1'ti rL:RIIiT.S m item betOts•. <br />V <br />