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/ C�l , Attachment A ' <br /> Designated Underground Storage Tank(UST)System Operator <br /> 09 • Monthly Visual Inspection <br /> Facility Name:ARW — j ' Date: �A • —� '— <br /> FacilitvAddress: A,1 jj t 40 <br /> Cit 2f, Zip Code. 9%g—;,d 2 <br /> Narre 071 UST Operator CorductiriS t Inspection: =7.w G J.-I< <br /> International Go until A. e7 Expiration Date: t <br /> Sign ur Phone: (?/4 <br /> Item Monitoring PaneilAlarm History / Y N <br /> Monitoring System Is powered on and in proper operatinp mode. <br /> 2 Monitown system is not current) showin an alarms or warning, <br /> 3 Alarm history reporGlog for the previous month is evaileble and has been reviewed by the Designated <br /> UST"rotor. Attach a copy of the alarm history reportnog to this form <br /> 4 Each alarm for the previous month has been responded to appro rlatel , <br /> v <br /> uEensors located In the tank-top conta'�nment have not alarmed jr)the past month, <br /> List all tank-top sumps where alarms occurred in the past montn; <br /> r . <br /> Nat@.SUmp3 wnera an AIAr/n nA9 OeCU/red in rlla pfist month must aE in5p®Ctfie W1WCs a 9ql J/JJed AArvICA hChMQiArI <br /> mwndad rC,and properly addressed,the cause of the alarm. AdaCh documfirrrotlen Verifying eppMpnpf,SeNICa to this M" <br /> mW, If sump inspections mculred record results m item 6,boitm,. <br /> UST System Inspection <br /> NOW visual inap�Qoon of sumps is ervy require#to sumps where M alarm Ma?occaradln toe past month for which there is <br /> m servkte record Y N " <br /> 6 <br /> 'rank-top containment sumps are free of water, debris, and hazardous substance. Sensors are 1 <br /> o located. N <br /> Sum Location <br /> Sump Locati n <br /> 7 S III containment structures are free of water, debrla and hazardous sup tante. <br /> Spill Containment Location Sill Containment Location -. <br /> Under-dispenser containment areas are free of water, dabrls, and ors hazardous substance. ns <br /> 6 are Properiv located <br /> Dispenser t/2 n ? Y N NA "Dis nser 911# i F= Y N N <br /> Dispenser W4 Dls nser 11112 <br /> Dispenser 616 Djenaner 13114 <br /> Dis sneer 7/8 Dis nser 16116 <br /> Paperwork Inspections Y N <br /> 9 Monitoring s s em certification has been cam feted within the lard 12 monthe, <br /> 1 Secoroa containment tests have beer performed in the!ast 36 months. <br /> Spill containment structure bucket testin was tom Woo in the past 12 months, — p <br /> 12 beak detector testingwas tom sled In the est 12 mons s. �~ t <br /> 13 Tank 6 htness testing was completed within the required time frame. x <br /> 14 ane tightness testing was comploLod within the r uired time frame. X <br /> Facility Employee Training " <br /> 15 1 All facility empioyeea have received the required "on-the-job"training within the past year. <, <br /> 16 1 All faclllty ernp:oyeas hires within the pact 30 days have received tht uVquired"on-the-ob"trainin <br /> C.4vO_Oesipnacetl'J37 Operates rsonihly inspection Checxhst_aeaohmmt A2.xa72;27/2004 Page 1 of` <br />