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MootiilyInspection Checklist TRARECEIVED <br /> QCT 0 3 2017 <br /> Designated Underground Storage Tank(US1) Operator <br /> Monthly Visual Inspection Checklist (I of 2) NVIRONMENTAL HEALTH <br /> Facility Name:963 1 Date: .26-20 11 <br /> FacilityAddress <br /> ci : Zi Code 77 <br /> Desi t ST OperatorConducU the Inspection: <br /> Intemadond a Corm ' Ieadon N: 5414 n Date: 6 goits <br /> S' pbom:: _ 7 <br /> Y-142K=N rda.-NetANWftbte <br /> [tem MONITORING PANEL/ALARM L=ORY Y I N NA <br /> I Monitoring tem is powered on and in proper operating modt_ <br /> 2 Monitoring system is not currently showing alarms or <br /> 3 Alarm historyreporNlog for the previous month is available,and has been reviewed by the <br /> Designated UST operator. Attach a capy of the alarm history on to to rhir rm J available. <br /> 4 Foch dannfor the prayinus month has been see oaded toappropriately- <br /> 5 <br /> ro riatel _5 Sensors located in tank-top containment sturps have not alarmed in the pmt month. <br /> 5a _ Litt all fankdapsAaarpswhere alarms octtrrred in rhaposi month: <br /> Y\l.fiSL SQL www nlig. <br /> Hare:Sunpr trhm as e7arw bat oaa.rt4ln ale paasfanrh coos ere(arPrdad wlm a gw7�tMsavtu Ierhaldan rupeedrdl0.sed <br /> preper7yadAssld fbam...aJfbsdorm.Atmrh darnnmfrttWn�uj(dhauypruPrWeinrolrtrofhir nyo.t <br /> IT !an a n afrsrt mordmwla 6 nun if.below. <br /> -.e - -r <br /> UST SYSTEM INSPECTION <br /> 6 Tank-top eommiraneat sumps are free ofvtater,debris,and hazardous substance. Sarson are located properly. <br /> oh:Pawl tun tt oe7 airrdle 1Vilrrrae slam Fal Oernr*"l Gs rbs axmmah orwhlrb lbmehaestrvYerocmd <br /> Y N Y JN — <br /> SantpLocadon: <br /> _ Slcm LouNon:S Location: Sltrn L <br /> Su Location: Location: <br /> 7 Spill containment structures atf Bea of water debris and hazardous substance. <br /> .Y N NA. I Y I N I NA <br /> T 1—Contents. >a Tank 3—Contents: <br /> Taok2—Collin h: +tt Tank4—Cantenw <br /> S Under cr caataimneo[arose are free of wafer,debris•and hazardous substance. Sensors are located o eel . <br /> Y I N I NA I I Y I N NA <br /> Dispenser ! D18 eraser t! Sw <br /> Do eraser I Simt, 0 1 1 Dispenser $, M <br /> DIronto Z S, Dit eraser 7 ju44'r AAAA141y <br /> DArmunv DJ eraser <br /> PAPERWORKDNSPEMON ,Y I N INA I•DATE DONE <br /> 9 Monitoring tem certification has bees cotopleted within past 12 months. <br /> 10 Semdary containment teats have been comple tad within rhe required timeframe. <br /> U 3 Illcontninmentstrtretrre uckat Testing was completed wiffin the past year. <br /> 12 Tank d fitness trstin was completed within uired timeframe. <br /> l3 Une tightness testing was complered within required timcframa <br /> 1.4 Other required lestir mainrenanee was completed within required timcfiama r resfMmintenmtca itmm below. <br /> TestWainhutance: <br /> TaNMainrarwnce: <br /> Teatlbfalnhnaace: <br /> I Y. <br /> FACMTrVYMPLOYEE TRAINING I Y N NA <br /> IS All tkcill em I em have received the fired on•the•'ob training within the at yeat, <br /> 16 1 AU facility employees hued within the pasr3o da have receival the Wred on4hr ob t aialr z <br /> Note: Any answerornN"should beeaplatredIn the comment section onthe following page,and will require follow-up <br /> action <br />