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N '-- -0 J (I1 <br /> c = -- rn <br /> w O \ ()1 <br /> co CD 0N = <br /> 'lrnnthh Incpection Cheeklist I RAC'11/2016 O— 0 <br /> (D CL A Q. <br /> CD <br /> W:�E <br /> 0 Designated Underground Storage Tank (UST) Operator <br /> o Monthly Visual Inspection f'heeklist n t,t2l <br /> CD <br /> M <br /> ail <br /> . ,tN Namr YOLtr 1).3Ic: <br /> - <br /> = Fanhn .1dir«` G.�--- O <br /> Grt<: ��—- - /ip Code. CD <br /> DesiL�nated L'ST )perator Conductinst the tn,jpection. <br /> Inrcraati+:nal C,dc Council ificauon t F7 1'6sfJ (� Fxpirattn❑hate_ /�p/�� n r <br /> � O <br /> - - - - \7f)\17(illl`•f. l'\`f l 11 I;�1 III`,lt+k\ � <br /> Item'_ - - <br /> - O <br /> 1 At mth.,nng> ;.1vmcred on and xt q:. <br /> 2 I�,lonitonne s�,te rn is not curreatly showing- <br /> 3 Alarm history reporvlog for the peas imus m <br /> Desi rated UST Operator. /Attach a coy v' <br /> a Each alarm for the rexiuus muntlt has been <br /> Sensors located in tank-top containment. �- <br /> -- ---- CD <br /> 53 Listall tank-top sumps where alarms occurretl in the past nen <br /> .'Joie Sumps w4ioa an alarm has occurred in the past month must he inspected unrers a qunti,,rd-ender tec-Itrir.tan respnn <br /> properly address.the mute of the alarm-Attach documentation vrn(tzng appropriate ser.ice:v tilts rey,er, <br /> it repured mord results in item 6,helow. <br /> --- _� CL <br /> UST SYSTEM INSPECTION <br /> 6 Tank-.top containment sumps are fine of water,debris,and hazardous substance. Sensors are located properly. ry <br /> orC Pauat ins edion o!srm i is orlr 2N.aLedin sumps Crean alarm has occurred in the past month for which there u no service record. 0 <br /> Su trip 1_oratiir,: ;p Q Sump Location: <br /> Sutrp I.ocaron: SLucation <br /> Sum Location b L t�/ Surn I�tcation: - — <br /> Spill Coritainment strucPures are free of water,debris,and hazardous_substance. <br /> I Y N NA Y N <br /> ank l - Contents: /J p Tank 3-Contents: <br /> ank 2-Content. fyJ Tank 4-Contents: Z)jr <br /> nder-cis eraser containment areas are free of water,debris,and hazardous substance. Sensors are locatedonerl_v. <br /> Y NA Y \ NA <br /> is ? Denser y/I oncrJ �_- <br /> is eraser 3-4 S X Dispenser 11/12 Z <br /> is en ser i%6 �/ -- - - Di rpenser 13/14 <br /> pis eraser 7/kDispenser <br /> G - <br /> PAPERWORK INSPECTION 1)ATE DONE <br /> onitorin s stem certification has been completed within Past 12 months. <br /> ecvndary containment tests have been completed within the required timeframe. I <br /> jWill containment structure(bucket)testing was completed within the past year. <br /> �lartk tightness testing"as completed within renuired tim._fi-amr <br /> ' Line tightness testinE was completed within required timeframe. _ <br /> other required testing/maintenance was_ completed within required timeframe. (List test/mainrenance items below.) 70 <br /> Test/,Matntenance: cD <br /> n <br /> Test/Maintenance: <br /> 0 <br /> 7est/Mat'tenanc•e: <br /> 0- <br /> FACILITY <br /> — d <br /> FACILITY EMPLOYEE TRAINING Y N NA b <br /> Lih to ees have received the regttired on-the-job training within the past year. o <br /> Tc to ees hired within the ast 30 da shave received the re aired un-the-ob traininco of"N"should be explained in the comment section on the following page,and »ill require follor-uP C) <br /> (D <br /> 0 <br /> rn <br />