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FROM :B.Z.SEP.UICE ATI0N MPI NCE FAX Ip. :916 `71 2540 26 2006 le:45AM P3 <br /> Designated Underground Storage Telilt(UST)Ope1•ator <br /> Monthly VVi.sual lnsTns"ection Checklist <br /> J <br /> Facility Name J ••- <br /> Fwi ' Address <br /> City rasion#g"�Gl'i.. ratirnI D'aie 04 !•=7- _.. -. <br /> irnoraaei r Q �bL•t" __�,,���� u�� �:�.�r _..�.., <br /> __ Y-Y . N=Nn.NA�NMA IIwMo <br /> I itaft system,is powatYd on and in proles oparating raad:. ceev ) �r l x nA <br /> Mon <br /> 2 Monitoring system is not cuarently showing arty&roma cm wandngs. Low <br /> pt J C <br /> 3 AIM hiarory reportllog fns''FTp, to 443i available,ar.d has b=Ek reviowed�T <br /> Dwignotod VST Operator. (Attach a COPY oftha<:lormr ltlsfor)reyore/log to tldeform(f avallabi,.) <br /> 4 FAtch alarm for the previous taout has been responded to apprrpriately. _ — -- <br /> 5 sensors tncated!n lank-top c7ytainmart sratgPx ltwve rmt alaam:3 m rhe past roon�i�a cG, Ps�c <br /> 5a LW all tank-tap sumps where alarm&occand in rfe 91";m <br /> Yaq'Sampe whm em alarm car E.xvrrsrt ur tht i+ger mrnrh+moat la imtpGnledankae a 5va,rfiud sGIV(OB techntcLm responded to,,rrrdProperiy addxmcd dre <br /> caaaG of thB&tarn,Attach dmwrrerrtame+ver(bwO avnrovrium"m'v e?fhb Mp " <br /> fPna D lmpeEJ am M Vad Gs NSW n ilwn 6,S•r•dw yy C6/jV/P <br /> UteX`SY'STd lNSPEC'T!I)x <br /> 6 Tamk-top eontab nratt sumps aro 8'ea of waren;•a' $,sa'.d hamudous svbsttm oe.Saviors ars loca!ed properly. <br /> Scat:+rami tmpC'ci(nn nfanvq+a le arty rvrWrod in"NW wlrrna an aiarM ata nECWrwd 1n I*print month for <br /> wkdah 6m V.n <br /> tampLacation -� SrmpLa_catirm �^, <br /> n mp cocgaon _ _ _ <br /> St�Loaarivn Sum Laotian <br /> 7 S AU containment sirt:cturea.ere fYee of w'rtere debris,and haza.-tbua subslwme — <br /> Y. N N4. _,_• t N NA <br /> Triol:l-Cnmtenfs Q'.'} Tank 3-Contevy �"?1 �,... <br /> ;ISutk 2-•ContcPrlx �G �Y.Se:� --- <br /> $ U:i3erdispensu contalltmeaa:areas am rice of water.dobris,aml hazardous s�tbataocY.Seasnrs ono loceuad pro <br /> Dleparser i/3 Divp<a+.ver 9 /10 •� <br /> D7p—Wer 3 J d _ L'7,wcm-er 11/12 i <br /> D�dvprsauer•5J 6 pLvpamsm•13/14 <br /> U1epePtoer7/8 —�� Dispenver IS/15 <br /> PaiPLrRWORK Y PI.CTtOfI Y N NA RATE 110tIE <br /> 9 Monitoring syatam certirieacibp has beau caatplettd within pas.-.1.7ynrntrhx. 7t .,_.. <br /> 10 Semondary IXMU moat taste have bees eotupleted-mithin rho reImo. X <br /> 11 Spill comalmnent structure(bucket)tesTiMS WAS CO pIOW wl&r the past Year. X <br /> 12 Tmtk Aghmm testug3 was a anpiNed within royui )d daic&mn_. _ _ <br /> 13 Lino tlghmass testing was rn nplatad witam regaircd t moframu. ^� <br /> .4 (),bar required tcstinWmamtt Dance was comple4ed within required timseme.(L1Af 1Ett mcilrtena are iremv hclow.J �� <br /> Teet/>fafruenance: QYf "C�T��Ywr � �d "1�3"t)5 <br /> XX <br /> T'evt/77'ainrananePi: � ��- <br /> - FACILITY EMPLOYEE TRAININGTX - <br /> 16 <br /> NA <br /> S .0i'd facitay ampbyees hive r xaved the t ahvd o:n die^Job Raining within the pent year- <br /> A'li t§cilltY emPbyoas hired vltltln the set 3D a have M06%.ed the required on-tho-Job traieinf:T--_T - <br /> Note.-Any answer of"N^she'11d be explained in the eomptont seetten em the Yollowiag p 290,and will rspaire fellow-op <br /> action. <br /> Page I. Nmember•2004 <br /> Ed Wd£V:TT 900? 9Z 'FpW 'ON XtJd WOad <br />