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Rpr 30 07 08: 30a • • P• 3 <br /> UNDERGROUND STORAGE TANK SYSTEM <br /> DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT <br /> Facility i s !Jar 't Dam' 7• Z9-66 <br /> Facility Address: 6tgyZ3H W " � 276 <br /> Name of Designated UST Operator CdrAw ing hmpectime <br /> Intematiottal Coda Cautei!Certification No.: uG �on Dale.`, <br /> sivaunt <br /> Phone Wv-'I S 0 ext. <br /> N/A-Not Ikable <br /> ltem MONITORING PANES./ALARM HISTORY Ycal No N/A <br /> 1. Is the mmawrism system powered an and in pLuM opernnng erode? <br /> 2. is the monnotisw sysmm not show' leak almns? <br /> 3. Is thc Alam Jlistary Repon/log for the pmviom month available,and bas it been rtviawed by the <br /> Dcmgnaocd LIST rt Aeach a gpy of0w alarm hurmy repoiViag to thin m an area <br /> 4. Has each alarm for theions month been W <br /> - -UST SYS'I7PM LVSPECTK/N - - - <br /> 5. Are tank-top contaummunx Sumps five of water,debris.Ltd haraedoms suhsmtce? Non:{(dr mwuv Isar/was"Ycv"sbp <br /> m nue 6 UmgM whw as atoms hor oeraond M&►e paw mmA moot be/agwpd ff a 4ud&d.nerraa uchmdaa hos mor re4l"U d to,and <br /> adAVXWA.AW tastyOfAd&!oras.Dila .=WWM ser ftmania Am&be Wa1010d0 ddr <br /> Yea I No Yes No •w"r <br /> Sump Location: ;: c_-.. Sump Location: <br /> Som Loentiaa 5 • <br /> 5' Location: n,yklL 'i:'1�',° <br /> 6. Aie sxll buckets runuimneot shucmre5 free of wuwiw.debris and hamdgm sabsuooc? <br /> Yam No NIA I Yes No N/A <br /> Tank 1 ID- Tank 41D- <br /> Tw&21D- W ludlof 0 ITsnk5lD- <br /> ItAIL-11T3nk61D- - - - - _ <br /> 7. Are under-dispemw contaummmi areas Geo of waim ddwis,and huaadous subaaoce? <br /> Yesj No i N/A 1 Yes No MA <br /> _ D'is -U2 <br /> Dib -314 -11/12 <br /> D -516 D' -13/14 <br /> Dis -7/I Dis -IN 16 <br /> S. Teak derocdon is propub located withiispamer commi»mcnt- <br /> Yes No I N/A I Yes I No I N/A <br /> 1!2 Fv1 F1 I El i Dis -9110 <br /> D• -3/4 Di -11/12 <br /> D' -5/6 -13/14 <br /> Li I Dis -15/16 am i ELI <br /> PAPERWORK 011M TION Yea No N/A Date Dome <br /> 9. ?AQWWfing SYstem Certification was widsia the 12 menden? _ 1 o G, <br /> 10. Line Leak Detectors were tmwd/outified within the pw 12 months? U Is -it -cc. <br /> 11. SPill bucket Ommimntnt stmucWra feted within the pan 12 moNLs? - t I 'p <br /> 12. Line dgbW=testltto=pkw within the rewinw time&Etre? ^ <br /> 13. S=mdwy contRinnIt tl tests C4W.PkW within the TgukW tiros liame7 • 2 -o <br /> 14. Enhanced Leah Ddmdm caWWed within the mquirtd time Same? _ [U RILU Im I <br /> 15, tOdler IaWimml Wstin0awntmanm wu complated wkdtin required time&&mel tZim t@u/mttiedenartce item below.) <br /> Describe TesNMaiNermmce; I A <br /> Dewribe Test/MaW&mnec <br /> PACILITY EMPL40YEE TRAINING I Yea No N/A <br /> 16 1 Have all fae- ' to ees.nrsivnd the requumd on-dto"ob naming wdhim the pw&y4m9 <br /> 17. 1 Have all 6,eifi to ees hired within the 30 rewmed ft reguLmd on-the t wenn ? <br /> Nota: Explain any"No"&trocar in tit@'Cwmmcutsr section on the following page.Tbos@ ismia requite eom=dve action&sett <br /> the UST oworrlopetator. <br /> Un-Y37-I/t wnh..eaidk.ora 9rt6ius <br /> _ <br /> 0i_9I L09Z/LZLDO <br /> X)N3NGIINGW ZZ OsbZiL69I6 <br />