Laserfiche WebLink
Apr- 24. 2017 2; 14PM ECEINa!r1 •6•Q 2 <br /> OCT 0 3 2017 <br /> MUMMY Iarpectionlatocklin WRAC 6113016 <br /> ENVIRONMC"�ITAL HEALTH <br /> Designated Underground Storage Tank-(UM•O'perafor <br /> Monthly Visual Inspection Checklist (I oft) <br /> Facilit Name: Gm d I Date: <br /> FzcM Address: <br /> Code. <br /> Desi t ST orator Con the Ins cation: �, <br /> bntemotional- Coon lrationDate: / / <br /> Si r Phone: <br /> Y=YMN=N NA-NttApptlnWn <br /> Lam _ MONITORING PANEL/ALAMthe <br /> Y N NA <br /> system is -' andin era tin mode. <br /> 2 Monitoringstem is not curventl she an alarms or warni <br /> 3 Alarm history rep or0og for the previous month is available,and by the!Deli bled UST erator. Attach a o the alarm hist rm ' avallable.4 Each alarm in the revious month has been ndcd to roc5Sensors located in tartk to containment have not alarmed . <br /> Sa List all tank-top sumps where alarms occurred in rhe past mouth: <br /> Vifase. Sop., <br /> Nott:Sutrq whenmf alum hoeamrrrtd In rhePari nonfh surf be hayeekdardana m <br /> Propertyaddrave{rhtcaoa Of ttrmnr.Atauh da®nanoic, rpon <br /> b Jlpedsrrvreklan raspo.rded f0.std <br /> rrtl/yhtaapprpytitfaaertin m rhir rreport <br /> Lr ht{rapatdr+e.Jrrin tress 4 below <br /> UST SYSTEM!INSPEC77ON^ <br /> 6 Tank-topeoWaiommt sumps are free of water,debris,and hazardous subs== sensors arc located pmperly. <br /> e:Yuntl a Ira rdrrdmyimar when na arena has oeenrrrd(a fit owtosonth rrhrrh there 4 no retire record. <br /> S"m Coconon - <br /> Ston Cocottes: W <br /> Slim Location: Sum Local/ons _ <br /> Slim Location: irric� S Lorntlonr <br /> 7 S dlcoalairvnentsWcMes freeofwatar debri andhasardoussubatasum <br /> Y N NA Y N NA <br /> Task[-Conrenrr. IPP/ Tank 3-Contfmtr; <br /> Tank2-Conterus. *Z I Tank 4-Contents: <br /> B Under-di mer containment areas are free of water,debds and hazardous subsiantt. Sensors me located erl , <br /> Y 14 NA Y N NA <br /> Dlr !tt{ D user 4 <br /> L1tt nser or M } r <br /> Oh ems' Dispense, 7 r4 <br /> �. MOW_ Llir ender <br /> 'PAPERWORE INSPECTIONY N NA DTE ONE <br /> 9 Ma:1orin s eerdfrebtionhasbeea ed within 12smaths <br /> 10 -bc5R9n conteimm:nt testa have been completed within thereused timeGame. <br /> 11 -Spilltwasimaxatstructure aclfct ttstiaff wasbred within die est <br /> 12 Took dAhmen vening was m tared within rc red time5mne. <br /> 13 I hie i mese td' was c tare[within required timeframe. <br /> 14 Other requiredtfatin maintemlacewascom I ted within required Tornetra!1S. isttat/inoinlenanceitems below. <br /> Teri/Mafntenanca: ;M1 <br /> 7 I?nlc <br /> irttenancc PSI 6 <br /> l iferrance: <br /> � -:_ . .., ~FACri,1TYEMPLOYBETI2AINING • . _ ,Y N NA- <br /> 15 1 All fall employees have received the required on•the-ob tmininx within the pad <br /> 16 1 All loyeas hired witbm theeat 30 love received the r 'ed ondhe ' b Iminin <br /> Note Any answer*11'"N"should he explained in the comment section on the following page,and will require follow-up <br /> aedon. <br />