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<br /> 'Ierrt / •' �/ �'>'�. _� I'himc (925) 389-126
<br /> MON''I 10RIM. I,ANII,/ ALARM IIISIOR}
<br /> IhI,r,,,ued on ;uul nm,, I,rummer onerati
<br /> n,,�n uonn .c,Mni nut ,urrcnn, shnginp fort) leak
<br /> I la .Alcan Iliston R, „n I. I... --
<br /> I r the pw% on, month available and ba, it hu n reviewed by the
<br /> _ 6 I)ca •n_,_ued UST Opo a ,r r,IMr ,h a rn l
<br /> / t r+l lhr uhu'nr hf,,lrn t t, au'N)o"r lu oboe impcction fnntl 1_ ��C�y
<br /> 4- I Hay<ach alamt for the �t rc uri5, nu,nth brrn Ir, x+nd�d lu a „ro matcld. �
<br /> -----------. - __ _- _ _---�---- ,,. r
<br /> ---- t ti l SYS"11 M INSPI < I ION �- ,a,
<br /> Are tank-toll containment sumps Oce ol"1r N —
<br /> P ucr. dcbns. and hazardous substance? �,,,ae_ ! th a, /rem I r ill,re pry^ld`
<br /> . ..-sk4'+++!t'm b. Sumps udrere an alarm has rrr ar r ed w O+e �a.,l month n+usl he inspected if a qualified.service techrtrcian ha
<br /> to.msl ra rrh'addressed.
<br /> Me ca¢sc o / ,rr.
<br /> the alarn+. Uncmnenlahon,-err tint appr nfat�c ice sh ld h aaach'd to sins re N U
<br /> No sumps alarm Yes
<br /> Sum Location: NO No sumps alarm es
<br /> ❑
<br /> Sum I up Location:
<br /> Sum Location:
<br /> Location: -
<br /> Are spill buckets (containment structures) free o❑f water, debt_[nand hazardous substance? Nes No N/
<br /> Yes No N/A
<br /> Tank I ID-Regular ® ❑ ❑ Tank 3 ID- �]
<br /> Tank 2 ID-Premium ® ❑ ❑ Tank 4 ID -
<br /> Are under-dispenser containment areas free of water, debris, and hazardous substance? �N
<br /> Yes No N/A - Yes �°
<br /> Dispenser- 1/2 ® ❑ ❑ Dis enser-9/10 ❑ ❑
<br /> Di s enser-3/4 ❑
<br /> ® ❑ ❑ Dispenser- 11/12
<br /> Dispenser- 5/6 ❑ ❑ ® Dispenser- 13/14 ❑
<br /> Dis enser- 7/8 ❑ EF ® Disrienser -- 15/16 ❑
<br /> Leak detection is properly located within under-dis enser containment. No NIA
<br /> Yes No N/A Yes
<br /> Dispenser— I/2 ® ❑ ❑ Dispenser 9!10
<br /> Dispenser-3/4 ® ❑ Er Dispenser 11/12 ❑
<br /> Dispenser-5/6 ❑ ❑ _M Dispenser— 131/14 ❑ ❑
<br /> Dispenser- 7/8 -- El [:1 ® Dispenser— 15/16 ❑
<br /> PAPERWORK INSPECTION_ Yes No N/A Date Dune
<br /> Monitoring System Certification was completed within the past 12 months? ® ❑ ❑ 4/3/2012
<br /> iecundary containment tests completed within the required time frame? ❑ ® ❑ 2{27/2009
<br /> pill bucket (containment structure) testing completed within the past 12 months? ❑ ❑ 4/312012
<br /> ❑ ❑
<br /> ank tightnc-" Ic,linr completed within the reyuirrdtime frame?
<br /> int tughtnc5', testing completed within the required time Dame? Li M
<br /> Ither r>:qulrcd testinE,maintenance was completed within required time frame? (List lesilmaiinn_lerrance items below)
<br /> I)escribe "I est/Malntenancc: 111-20 1.3 & 7 1`-20 1 .0 4/3/2012
<br /> Descry A est/Maintcnancc _ -
<br /> - NA( ILLI Y I,MPL,OYH I /'RAINING Yep
<br /> lad ? No Iyl�
<br /> 9tie &II T�� )list' emj�lr ces rc�cis�d the Icquucd un Ihcio�h a unto within site Nast year, pmy-
<br /> itrall� ilil� ernplusccslinedw)thinIhrpastillJ.nvtt��� I��dtheI�qulredon-the Sobtraining7 l
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<br /> iatn any "No ans�A CI s ut thr ( ununcut, section u❑ IIIc lollowing page. Those Issues requir�o
<br /> Retie ,,ion
<br /> [PSI .Iwner operator.
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