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D 0 CD GE TANKS ECT j0S <br /> s <br /> m F°en�E ?fAT.��DERGROUNVSTM�,011t" ,,Sp <br /> � <br /> 3 3 .etnty Mttpr UST OPERATOR_ I ntx' <br /> [aloe o Ad°^e..: 1g a a*",Cnw,m cnr StoekUo^ 017 . 0 <br /> Cr IS ' Da' 1e march tion Date: 216/2 <br /> TI terrytt l co"nei conlunins lnM'eadon_�Ntltl�� EaPi�. (530) -9892ext. <br /> /A�e <br /> N C"tine+tion No.: e1s5�tso-UG Pttl' ties No N <br /> in <br /> � II15fD <br /> N Ul Is the Monitoryn a MONITORING Ill LI ALARM RY <br /> N Is n'oni ete,n 'RIVITCd lttode4 b the - T <br /> (D Desie Al> 1'�ory R not currenq ashowin an leak III S? �s it bear rcr'eC ion °rm. _W <br /> C Hat ees UST -Ponnog for the virus month available.alt- o to III Ins ^' <br /> O each atm for the fon Ar/ach a c.��rhe alarm hat I' Wes..'sr p YlJ <br /> virus month hien its nded to 0 4 waa <br /> OAre <---- d 1,1 <br /> ftp '(3 a t4 s�upv q„cw01a'nment sum UST SYSTEM INS ECT"S SUhstattea Yot�lectin rhas Bw M r T <br /> _ aaye Arae ata Ps(ree of water,debris,and 1Ja vw i rhtd to Ihls MParl' No J <br /> O +4d rhe r'e A.a'rvnrJ rn rlt run nmrh~I M v Id be aro Ytl _ <br /> Stan <br /> saner afMe'll rm.(hiwn.r amrur,er t xr,0e� X <br /> = S I'°cation:p Yea No EL X - <br /> REMIUM Location:DIFS <br /> CD <br /> I'O�dOn-tlbtLEADED X Stun tion: ;... <br /> ,z �_ Are a ill buck x Sum Lova ryo N/A <br /> In T ett contaiee ofnment strttetttres bwater,debris.and hazardous substance? Ytl <br /> (n ank 1 <br /> ID-P M <br /> Yes No N/A CD <br /> � Tank 2ID_ L IU <br /> Tank 4 ID- <br /> (C) <br /> D- <br /> (Q fartk 3 ID-p1ESELDED Tank 5 ID- <br /> under-di Tank 61D- 0 <br /> c0) Iv containment area free of water debris,and hazardous substtutce? Ytl No N/A <br /> (D hs nom- 12 Yes No N/A - <br /> (.0 is r-3/4 Di -9/10 <br /> Ills nser- Di ser-11/12 X <br /> OI W s nser-7/8 Dispenser-13/14 x <br /> Dis neer-15116 <br /> ak detection is to I located within under-diimenscr containment. Yes No N/A <br /> nser- 12 Yes No N/A <br /> Dispenser-W <br /> r-3/4 /1 rn <br /> Dispenser 11/12 _ X <br /> -5/6 Dispenser- 13114 <br /> 7/8 Dis nser 15!16 x <br /> PAPERWORK INSPECTION Yes No N/A Date Done <br /> itorinZ System Certification was completed within the past 12 months? X 1111812014 <br /> -D LElers wVre <br /> /certifted within the t 12 months? X 11118/2014 n <br /> o inmeure testin com leted within the 12 months? X 11/1812014 <br /> o ng cwithin the required time frame? x VPH <br /> ment leted within the wired time flame? X VPH m �tectileted within the required time frame? xo n mce was com leted within r aired time frame? (List tesbvmaintenance items belowX Z Intenir uali / a r 101812014 <br /> ...... _ <br /> CD CD <br /> FACILITY F.MPLOYEh TRAINING <br /> Yes No N/A <br /> CD em to ees received there aired on-the- ob Uainin within the ast ear? X 01 <br /> Isl <br /> em to ees hired Comm otssec0on on received <br /> ow ng paC re ired on-the-'ob trainin X <br /> ry v. ,,Swcrsin the` g Those issues require corrective action from, <br /> C:) Jr. <br /> wwtv.uaidomorg <br /> Ir <br />