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Feb 05 07 09: 05a p, 3 <br /> Designated lindzr D <br /> gr llncl Storage Tank (UST) Operator <br /> Facty Netae Monthly Sris1w Ins coon <br /> CiChecklist <br /> Facility Ad_dtess 7 z z Date <br /> ty .- "'�---- <br /> Interna@ co-- <br /> CaQOn# <br /> Sition Date <br /> z-12Ji/2 z�7 u�• <br /> Phone <br /> 1 Monitoring SxMm is powered on rad in Y=� <br /> 2 Mom ngsystemis nOtcurD pro roPeratingmode. �� 0 ! =Na NA eNotA liubt�` <br /> v <br /> 3 Alarm history report/1 for the previous month aljmrs wacliags. CJ N h,l <br /> Desigoated UST available,and has been reviewed by <br /> Each alarm for the (I7ach a copy ofthe aLz m htrrwy repart/!Pg to dds form ifavairable.J <br /> 4 previous menrtt has been 5 Sensors located in tank_ Desponded to oP1y' <br /> mP containment suahps hav not aleratd in the pan- a.2C o <br /> 5a Lzsta:!tank-top eSwhre,zfarms x a7� d+l= <br /> oared!n[x past month K/� ? <br /> Note_-%RVJ where on !m omv"dm r <br /> ewaex <br /> mar grd,.lana.Aaaeh donor don „`"`:['"°"'�`m;aKve ,v . we kd ad, �dw. <br /> If mar ftvw 'M Is1Yir+soypruariak.rrrHcemricrrepmt wxartrma„�.ed,,. <br /> reguned rrotrdrerllis tom 6,3u'an- <br /> G1V <br /> USTSYSTEit!VWECT70 <br /> 6 Tank-top cortta®ent sirups an:free of water,debris,and hazardousare Sated <br /> Noce:YisavffgMd-1O"Of=Mpa is Mt,requbvdin=P where an amm hn omaredbr d+rpaai.wnihfar Play <br /> which[laves noserv&v"Cord <br /> Y N x x <br /> Sump Location Swnp Lo,:otion <br /> Sump Location Stoup Loeation <br /> SumpLocadon S LaarSon <br /> 7 Spill CoWakmww Stmctnres are free of water,deb;is, and hazardws subSe. <br /> Y. N INA I Ly N I NA <br /> Tank 1-CoAdaws $ Talc 3-Coraenrs 4 J141 1 <br /> Tank2-Consists Tank 4-Contents pi ef . <br /> g Under containmmt art as are free of water,debris,aad bazudous si bstanca Sensors,ue loemead 6IODt7 . <br /> LRspertser J 11I Dispenser 9 /10 <br /> Dispemer 3/4 Dlspe»ver 11/11 <br /> Dispenser 5/6 Diryetcter 13/14 <br /> Dispenser T/8 Diapucre+-I5;16 <br /> PAPERWORK LNSPECSION Y N NA DATE IIONN <br /> 4 Monitoring system certiif=tion lees been completed within past 12 manths Xar <br /> i <br /> 10 seeaodwy eontsamew tests have been completed wul:m <br /> within the red timm&-me. X r-o"Y7 <br /> I t SpM containment strucnme(bucket)testing was completed withto the past yan. X <br /> 12 Tank tines testing was completed within requkic timeframe. <br /> 13 Line tightness testing was COUV]exd within re4nrcd tnieframe. — <br /> 14 Other requited tesunglmamteou ce was completed within requiitd timeft ne.(List zeWMaWeiwnce Hems below.} <br /> Tesd&b a= ' rl X <br /> Test/Afairderrm[ce: X "-- <br /> Trst/df®+ru+anaa: X <br /> FACHXrY EWLOYEE n LINING Y N NA <br /> 15 AR facility employees have tete xod the rcgoacd on+dJob traff ing within the past year. X <br /> 16 All facil' hired wid is the Hast 30 days have receiy d the regaited on rheyob X <br /> NntP_ Attu adSWer of 66N-should be explained in the comm eat section,aa tate following page,and will require follow-u; <br />