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Ma r. 27. 2017 6:32PM E NEU3� 8 <br /> OCT 0 3 2017 <br /> Monthly Inspection Cheeldttt HEALTH <br /> ENVI1WAL <br /> nr-PART NA <br /> Designated-Underground Storage Tank(UST) Operator <br /> Monthly Visual Inspection Checklist (1 of2) <br /> raciu Name: Date: 2.-7 <br /> raoW Addams: <br /> Ci ZID coda: <br /> Deal ated Wr O (or Conihicting the Tnspection: <br /> International C ouncl tion#: C?tt , tion Oate: / / <br /> Si Phone: 8- <br /> YaYn N�Ne NA-NotApptW4h <br /> ItemV MONITORING PANEL I ALARM HISTORY Y I N I NA <br /> 1 Monitoring tcm is owered oa end in co a tins mode <br /> 2 Monitoring tem is not currently showiax any alamu or warm <br /> 3 Alum hictory re-part/log for the previous month is available,and has been reviewed by the <br /> Designated UST Operator. dtmch a cOPY o Oro alarm history zeiiart4ag to thfYform f avail b1m) <br /> 4 Each alert for the previous month has been respoodcd to a o " rely. <br /> S Sensoo located intanx-wpeontainmcntsunvshffVCROt2lAMWAin the est month. <br /> So List an rank-lop tum, ?whoa alarms attuned in the part mo(nth: <br /> �1rnc See. t^�mrn rCG <br /> Xetr.•Sumyr whoemt alarw lxvoeew.rrd la thepaamarto5m�rt bt inrptefed uafura gmllaed teniae hzMddea rrtpwde/of outs <br /> PruPe•fl odd�eaud,rhe sure oJehe dura-Atlarh daamenteeiaa rerjbinp approylwrraviu to th4n¢urt. <br /> moo If requireg ft td mulls In law 6.balm, <br /> UST SYSTEM INSPECTION <br /> 1 -6 Tank-top conlemmem sumps are free of water,debris,and h=dom substance. Sensorsare lontcd properly. <br /> -OWN:kraal r edlen4 rrp! t"4 dab web ua renlu terata. <br /> Y I N r—V1 N <br /> Sum Inaarlon: * ><I Sum Locadon <br /> Su Lacallon. '� >9a I Sum Locarfon: <br /> Stun Location: <br /> &MP Location. <br /> 7 Spill containment structures arc Gee ofvwhx debris,and h1211rdoos subshmce. <br /> Y N NA I Y I N INA <br /> Tank I-Canrmts: "a` Tank 3-Con(rrts: <br /> Tank2-Contents Tatk4-Contenu: <br /> 8 Under cr&-muiamcor areas are free of wets debris and hazardous substance. Semon arc located <br /> Y N NA y N I NA <br /> DV enter tllrD1 enrar*M <br /> D earrr�1 L% D eruerfllll <br /> DLM&Lzff411111111l2 enter <br /> Dis tttlwDtr eraser <br /> PAPWWOAK INSPECTION Y N NA LDATE DONE <br /> 9 iiiixtem crAffication bas be=completed within put 12 months. t <br /> 10 secondary eotblammt tests have beta completed within therequired tkwfratae. <br /> 11 ftillcaatalnmemtstrueture ttckct testing was completedwithin the poor year. 1 <br /> 12 Took tihmetis testing wall completedwithin requiredtimcfimc. <br /> 13 Line tihmess testing was completed within r iced timcGvnc, <br /> 14 011ier required teetin ntanance was completed within required liracknic. LW rarthnaintenance ilEau below, <br /> Test/Matnrenance <br /> Twomaintenance.• <br /> TadAfafntomttee: <br /> PACILMU"LOYEETRAMG IVI N NA <br /> IS All foal- cin to tea have received Ilio ircd on-the-job trainingwithin the saa ear. <br /> L6 All l ilii to hired within tba est 30 da shave received the am theyob ttalnin . <br /> Note: Any answer of 9W should he explained in the comment section on the following page,and will require follow-up <br /> action. <br />