Laserfiche WebLink
Designated Underground Storage Tank (UST) Operator <br /> 'vionthigo tg"ins� clAOChecLiist <br /> Facility Mame: @p f (,. ,. FIGO /IJ&,t.T - tV <br /> Fsciiity_ Adrlress: lt}�i� r+VJ(49 FVGPT1-,' EN7AL <br /> City: Jk —� EPA R T h Code: <br /> Designtued UST Operator Conducting the Insoection: r <br /> International ode Cou it zmfication T: -�V G Expiration Dam: / r / ; 0 6 <br /> Signature: Phone: r p - <br /> Y=Yes.N=No.NA=Not Aopii©bie <br /> i Item MONITORING PANEL/ALARM HISTORY Y i N NA <br /> 1 Monitoring system is powered on and in prover operating mode. it 11 <br /> Monitoring system is not currently showing any alarms or warnings. I <br /> 3 Alarm history reportllog for the previous month is available,and has been reviewed by the <br /> Designated UST Operator. (.mach a copy of the alarm history report/lo to this form if available.) <br /> i 4 1 Each alarm for the previous month has been responded w appropriately, <br /> 5 Sensors located in tank-top containment sumps have not alarmed in the past month. <br /> 5a ' - List all tank-top sumps where alarms occurred in the past month: <br /> .Vote:Sumps where an alarm has occurred in the past month must he mspeered imiew a q=41kd ser nce technician responded to,.vrd <br /> properiv aatimssed the:mse of the alarm,Attach aacnmentanon verO ing aopronrone servrce to this report. <br /> 'f=mv imDe uon is.-ealiord,record re.ndis to item 6.i,oi w. <br /> I <br /> UST SYSTEM INSPECTION <br /> 5 Tank-top containment sumps are free of water.debris, and hazardous substance_ Sensors are located properly. <br /> —��Note. Jisuai mimeaion in nmms a oniv reburied in sumps iumm:an alarm iva occamd m(he pair march for winch inere is no mm r record <br /> f} 12N!< Tye V t Y <br /> Sump Location: Sump Location: <br /> �— <br /> Sumv Location: ' Sump Location: <br /> Stone Location: Sump Location: <br /> Soiil containment structures are free of water.debris. and'hazardous substance. <br /> I Y� Y I NA YIN NA <br /> Tank 1 -Contents: Tank 3-Contents: <br /> lank 2-Contents: f I i Tank 4-Contents: <br /> rider-dispenser containment areas are free of water.debris. and hazardous substance. Sensors are located nmperiv. <br /> Y ! N I NAI Y v tiA <br /> Dispenser 1/2 j i Dispenser 9 10 <br /> Dispenser 3%42 <br /> ispenser 11,'1' <br /> Dispenser 5 i 6 Dispenser 13 14 <br /> Dispenser?'8 jj ; Davenser 15:16 <br /> PAPERWORK INSPECTION Y N NA DATE DONE 1 <br /> Monitoring sysmm certification has been completed within past 12 months. -0 <br /> 10 Secondary containment tests have been completed within the required timeframe. <br /> 11 Spill containment structure(bucket)testing was completed within the past year- I 3-Q <br /> i? Tank tightness testis was completed within required timeframe. <br /> 13 Line tightness testing was completed within required timeframe. <br /> 4 Other required testis maintenance was completed within required timeframe. :List rest/maimenance items below,) <br /> ' TestliWaintenance: i I <br /> TestliWaintenance: <br /> { Test/Maintenance: j <br /> FACILITY EMPLOYEE TRAINING <br /> All facility empiovees have received the required on-the-job training within the oast year. <br /> 6 All facility emplovees hired within the past 30 days have received the required on-the job raining. <br /> Note: Any answer of`N"should be explained in the commednt section on the following page. and will require <br /> follow-up action- <br /> a <br /> °beerf Sentemoer <br />