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FROM :B.Z.SERUICESTATION MAINTE CE FAX N0. :916 371 2540r. 22 2005 10:42AM P9 <br />Designated, Undergroun& Storage Tank (UST) Operator <br />Mnnthly ViSUA Inspection Checklist <br />- w <br />Facili Name: s_lj,, <br />Facility Address: I 1 t I E. <br />Data: 77-5s; <br />Ci : <br />Zip Code: <br />d <br />Designated UST OpaatQr Coaiiuotisi the I aetfosr. ' <br />SuraLecatlon, Sum Laoatian; <br />International CqgLCM011 Certf a, cin # 25 2 - CA <br />Ex ]ration Date: <br />/ { / v <br />Si nture: <br />Phone; t4'.) <br />) l Z <br />tem MONITQRMG P NEL l ALARM I3ISTORY, Y 'N NA <br />1 Monftorin s stein U powCiC4 on jMT in' ' r or opirutW mode. <br />2 Monitorin k system is notcurrent] , d alarms or warnin s, <br />3 Alarm history report/log for the previous mbnih is Oailable, and has been revfewed by the tr <br />baaf tad UST b crater. Attach a co lha altrfin histo -re ort/lo to this,Aren'Lfavvilubfe. <br />4 Each alarm for the previous month has been re's bnded to a' ro riatol , <br />5 Sensors located In -tank -top co opt supe s,havomot alarmod in the past month, <br />58 List all tanlwop Bumps where alarms occurredin the past month: _ <br />Now .AwWs phery an alarm lar occurred in tke part asowh must U lniptoted wslaai a qualified servlae technician rorpo.ndod to, dnd <br />properly addrrrud the oaute of #w alarms k&xhdocwrwt► Don verl(ying approprkrta sekvtse. to this report, <br />ln,r rtton � rR silrid rtaard•result+ itl.ttem 6 6e1aw, <br />YST IVIINgPEC'T'ION <br />6 <br />Tank -top cbntaininient Blimps' are 1yee. bfVi Wr, debris, and haaardous sub9tance, .'Sensors are located properly. <br />ars: 1'l tool ins eMto>i a is pined n'r where an alarm hat accerrred ire rhe ast month ar which there lJ no rervta record <br />Y.... N <br />_!&mp Location: Sitttt Location; <br />SuraLecatlon, Sum Laoatian; <br />Sump Location: S-un;p Location. <br />• M-oaT+tal w,ot7.rbc'i•'twlisYCT� 0E-wtii:6Y't1117Y1 '' 'I'i'ii?EAtiliU' "lE b iA71°Cf� <br />Y N NA . V. N I NA'' <br />T4A I.- Contents:'... Tunk 3, Conlents; <br />Yank -2--- Contents; Tank 4 = Contents; Ell Pk^ <br />$ <br />Undcr-die onsor oo tainment areas Ora $eo'bf wv at& ! debris and hazardous substance. Sensors are located properly, <br />Y N''NA Y 'N NA <br />Dis ensar 1/ 2 Dls enser 9 /10 <br />lseraser 3 r 4 pis eraser 11 12 <br />lls erlser S / 6 I3fs enser 13 / 14 <br />PAPM—WORK INSPECTION <br />4 MonftoritA a stera3 cartifica i ti a been o' letad•w thinpast .12 months. <br />10 StobnqEZcontaftment testi have bcGri or}t IeWd within the re4uired timeframe <br />11 Spill <br />potltaitune rat strucNxo u ' e fQs#jp ,ftco toted within �tht ast ear'. <br />12 T&1k ti tness testln w 'aoMpletod•with' ro d eframe. <br />i3 fine t3>rhtness testinzz. Was completed within raoulredtheframe. <br />Lill Tesst/Mai,zlenance. <br />TestlMszlntenanae: <br />TWIMalponaoce.. <br />IP'ACILITY EMPLO E9 TRAINIM <br />15 All faaill . em toe have -received there uirod oti-the-job training, <br />16 All1kcillry em to ees hired within the Eut 30 days havo receiVed the <br />Note', Any answer of "N",should be ekplafaed In tho comment sesutfon on <br />follow-up action. <br />Fsge l of 2 <br />page, and will regtrirc <br />November.2004 <br />