Laserfiche WebLink
N - v CP <br /> c = ern <br /> to O O N 2 <br /> N O O O <br /> UNDERGROUND STORAGE TANK SYSTEM CD � 00CL <br /> ESiGNATED UST OPERATOR MONTHLY INSPECTION REPORT <br /> - - T <br /> Inspection late: CD <br /> ,.,. <br /> CL 0 <br /> IT y <br /> amc .r Designated UST!!�*aerator ConducNP,Inspection: 7 ' <br /> of 1t/.l i-=if -l r=N,G r ..— I -t <br /> ternarional Code Council Cettiiication No.: Expiration Date: <br /> ignatum' - Phone: ( ) ext <br /> CD <br /> Vot:mlicablt� <br /> MONI_TORMG,PANEL/ALARM HISTORY _ — a - Yesi No j N/A � i <br /> vont )rir .\stein pmvcred on andrr operatinode? --�� u ❑ <br /> r.onrtoriog etstettt not currently showing any leak alarms9 <br /> t hat n Nislor y Reportfogy for the previous month available,and has it been reviewed by the PSI ❑ . <br /> �t:_::atett US r Operator? (;Ittaclr a tt�t�Qlt)? alrv'm hicton rLpnrt/Iog to this inspection form., <br /> -- - ... <br /> ;h :,ianr,-Ior the rrcvious month been responded to appropriately-? --- y <br /> --_ UST SYSTEM INSPECTION <br /> 5. IAre tank-top containment sumps free of water,debris,and hazardous substance? :vote. f the answer to Item a was 'Yes."skip <br /> to Mens 6. Sumps when:an alarm has necurred to the past month roust be inspected iia quaked service technician has not responded to,Jnd rn <br /> nratx*rn�adA=.%•;i.the=zse of Lhe alarm Ax-vinetuatron herr in a ro riate service should he attached to thus re ort. O <br /> lig _ e No - _ ;i' Yell <br /> ISun-, Location: - ?...,C,` --- Sump Location: := E?•c.=,�c� 0 <br /> Sump Location: ;�. ` ' _ �[/] ❑ Sump Location: / - - �" �.. 7 ] Lj <br /> buci<ets tcautainment structures)free of water,debris,and hazardous substance'' _ <br /> -- -- <br /> I Yes No N/A Yes No ti;.�. CD <br /> --- -- <br /> I ank 11D- v ` ❑ ❑ I Tank 4 ID- !� ' " ❑ a <br /> Lj -- <br /> Fan], 'D- 2, _ - —- EJ L] Tank 5 ID- z <br /> 1 ;tk ; LD- .D Ll Tank 6 ID- s ;� <br /> Are tinder-dispenser containment areas free of water,debris,and hazardous substanceP. <br /> Yes, No I N/A Yes' No N/A, <br /> Dispenser- j ,, ,, jCiZ I El I El Dispenser- J r <br /> Dispenser- ' - <br /> ,t_,_-_t, -s euser _ <br /> ❑ <br /> —Dispenser- o <br /> - <br /> CD <br /> =' 1_.1 7 .a<._ ❑ I ❑ Dispenser- I ❑ I LlO <br /> ,; coon rn rh located within under-dis enser contaitunent. <br /> Yes_ No N/A Yes No N/A P <br /> _r t ❑ ❑ -Dispenser- <br /> 72 �T- <br /> --'r--L ^ f, Dispenser- <- S _ ❑ o <br /> - _ Dis <br /> Dispenser- � rte" Dispenser ❑ ❑ ' ❑` <br /> PAPERWORK INSPECTION <br /> Yesj No I N/A Date Done <br /> 9. Monitoring System Certification was completed within the past 12 months? <br /> 10. Line Leak Detectors were tested/certified within the past 12 months? ❑ e <br /> IL Spill bucket(containment structuret!' <br /> co leted within the t 12 months? ❑ -_/ <br /> 12. Line ti tness com leted within the X51 <br /> 13. Secondaryaired time frame? o <br /> containment tests leted within the aired time frame? >v <br /> 14. Enhanced Leak <br /> I5. Other DepEaction co leted within the tired time fume? C 0 <br /> o was mainneaane <br /> eted wtthtnt irewdred,tirne fiame7 (List tesdmaintenance items beltltv.j � Q- <br /> �, d <br /> G Yes No N/A o <br /> n� within thea' <br /> � yew, � o <br /> m 01140-'ob trainin w <br /> Cn 17wse issuas t'egt+ire corrective action fro v, <br /> 0 <br /> rn - - <br />