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L4 <br /> t <br /> t V� <br /> � <br /> t <br /> (kncral t'.n�inrrnug A IL,nu�l„u-, ( 'ol/I)Gt ('10 Nu. 742466 t7 <br /> -. alai ulcn:ulec l'umt(urtn ni I.Irrin�;�� ( 'uulrar�ui _- <br /> ices, Inc. �„u i,c( (mg) 462-2961 <br /> Designated Underground Storage Tank (UST) Operator <br /> g g g � <br /> Monthly Visual Inspection Checklist <br /> Facility Name: Date: <br /> Facili[ Address: <br /> Cit Lip Code: <br /> Desi nated UST ng the Inspection: Larry A. Williams <br /> International Code ouncil Certification #: 5242370-UC Ex iration Date: <br /> Signature: Phone: ( ) <br /> y --Yes N =No, A <br /> ItemIF NA=NutA INY N NA <br /> MONITORING PANEL/ALARM HISTORY - ,, �.:. .,.<•�..• <br /> 1 Monitoring system is veered on and in proper operating mode. <br /> 2 Monitorin s stem is not current. showin an alarms or warnin s. <br /> 3 Alarm history report/log for the previous month is available, and has been reviewed by the <br /> Desi nated UST Operator. (Attach a copy of the alarn[ history report/log to this f0nn if available.) <br /> 4 Each alarm for the reviuuc month has been responded to appro2riately. <br /> 5 Sensors located in tank-ton containment sum s have not alarmed in the past month. <br /> 5a List all tank-top sumps where alarms occurred in the past n[onth: <br /> Note: Sumps where an alarm has occurred in the past month must be inspected unless a qualified service technician responded to, and <br /> properly addressed, the cause of the alarm. Aitch documentation verifying appropriate service to this report. <br /> &W inspection is required, record results in iters(, below. <br /> UST SYSTEM INSPECTION <br /> Tank-top containment sumps are free of water, debris, and hazardous substance. Sensors are located properly. <br /> Note. Visual in.r ection of sums is onl re uired in sum s where an alarm has occurred in the as(month or which there no` ervtt` <br />