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11/23/2016 12:57 2098392001 TRgC ^ �/1 EI� / 07/15 <br /> ,`.{` <br /> CV <br /> 0 3 2017 <br /> Monthly 1rn ectivn CLeddW TRAC/UM16 <br /> `N,/rnr�ataa-nlTAl ��ALTH <br /> Designated Underground Storage Tank(UST) op fA,RTMENT <br /> Monthly Visual Inspection Checklist (i of-2) <br /> Facility Name: Date. i <br /> Facility Addcew <br /> Ci Zte Cock; ] <br /> Deni ted W6T or Conductingthe in tion; <br /> International C ouncil Ccrtificaiitm N; E "on Oax: 1 / <br /> S Phone: <br /> Y=Y 11=, NA=Nat Apprrablr <br /> Hem _ BiOMIiDRING PAIILI,/ H[57DRY Y N NA <br /> ..1.. M ..is ®wad m mock. <br /> 2_ M is not st w-- 612nm or <br /> 3 Ahem hmory rtportllog far He pac.iom ammh n available,and 6m been ta:riawet by the <br /> _ [1S=r ARa[sla 7lM ClmA fO 1hG nMd1�/e <br /> 4 EM&alarm for dtc mon01 has berm 10 <br /> 5 Swop IoeYed m mak contikmtetu lave trot stowed in the act nnNh <br /> Sa - Ilst all hurl>top nave ataimr occurrof in Me part <br /> xar saga.in.a.Imw res araareil is lAcpcn a.,.ds wqr tr Wy.CN/w,v e...rule+,n.ly 1a.#ele/m,eppred to.d <br /> r.q.ry.d6aad.rire��.grA.arI A4.*do[x.enm:e...*6 app m%mv. f. mem span. <br /> b r.cwrd/.> ft 4 hen a,49. <br /> EST SYST@H Qt$P[C.7101t1 <br /> 6 ==-top txtxthmamt nzmps are 8a of water.ddam,sad haardou wbstance. Scnsws are located p mpvly. <br /> Rww/ L !. .hr....atmw ia+eeo.,e/b MfNdenb...vAer <br /> Y N <br /> (ncatfon' �► :./ �Lomd�- <br /> Up_. Sramdoo! �'G.•P r <br /> 7 eotthimoent amo.,s 6oe of-mam mid hamdom.„t.�...,... <br /> Y N NAFYI tt I NA <br /> Tank I-Canfo/tr: Tank 3-Cosuatar -. <br /> 7adt 2-Coramu: Tm_aic 4-Co»/tltbr.$-Q4 � <br /> 9 U eeotatmttat m¢&ce of wapa, ttnd bazimAx4 submuco. 8cmft we looted _ <br /> Y N I NA I Y 1 N 1 NA <br /> 1 Din. <br /> is/to <br /> PAPERIYORK LMISFECTION _ Y I N NA DATE DOPE <br /> 9 Amilorox 1, cau@eaum has barn oympkftd wrd[m pV 12 mondw6117/WiQ <br /> 19 molat»mem mm base been wrhirm the timeftaanc. <br /> _ I ca atmmatt guttae(bulla was Itacd within thepm year <br /> 12 Tank d Item ecspe�nsa mn )atd within tom'nd cat6ntr, <br /> 13_ '_Lim 11t47— war cotnpMcd mfhm c .cd nmeftam_c. <br /> la . OIlrcr rcqwmdRatl 'rawinfetmrw wtta New within tmre6minc. I0"m below <br /> _ 7a1/MaBrhamxv <br /> TenMafrrkW44cr <br /> TotYMahaosmeec <br /> _-_ - FACILITY EMPLOYEE TRAINING Y N NA <br /> 15 1 All fm:Rky hnc mm ved the TqFned on.tbe- "his the <br /> - 16 1 AU&cdtty hired withm the 30 clava have rcoer.ed the aMEW <br /> Note: 'y <br /> answer of"N"should be taplained is the comment mctwnon the following page,and wilt requim follow-op <br /> action. <br />