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SAVICE STATION CHECK AT <br /> STATION ADDRESS <br /> CITY <br /> WIC NUMBER <br /> Tank Material Fiberglass Steel ❑ Fibersteel <br /> Tank Type Single Wall Double Wall <br /> Line material Fiberglass Steel Flex Line <br /> Line Type Single Wall Double Wall Trench Containment <br /> Waste Oil Tank Single Wall Double Wall Above Ground <br /> Waste Oil Line Single Wall Double Wall Direct Fill (no Product <br /> Lines) <br /> TANK MONITORING SYSTEM WASTE OIL MONITORING SYSTEM <br /> QTY ITYPE QTY I TYPE <br /> Interstitial Monitor Wet Dry Annular I I Interstitial Monitor Wet Dry Annular <br /> TANK FILL AREA <br /> Qty Product Drain Caps & Lids In Product DropTube <br /> Operational Gaskets Good 1.D. Distance <br /> In Place Condition Tags From Tank <br /> Present Bottom <br /> Regular <br /> Plus <br /> Premium <br /> Diesel <br /> Other: <br /> Waste Oil <br /> VAPOR RECOVERY AREA <br /> Qty Product Caps & Lids In Vapor Pressure <br /> Gaskets Good I.D. Relief Valves <br /> In Place Condition Tags Installed On <br /> Present Vent Stacks <br /> Regular <br /> Plus <br /> Premium <br /> Other: <br /> DISPENSER AREA <br /> Product B.S. : Balance System 1 : Float& Chain <br /> H.S. : Healy System 2 : Beaudreau <br /> V.A. : Vacuum Assist 3 : Veeder Root Stand Alone <br /> 4: Veeder Root to Console <br /> Regular <br /> Plus <br /> Premium <br /> Diesel <br /> Other: <br /> 1. Include copy of set-up tape 10. Are sensors located at bottom of sump <br /> 2. Include copy of alarm tape 11. Is Confined Space stenciling complete on sumps <br /> 3. Change all light bulbs on monitor, even if still lit 12. Take digital pictures of sumps showing sensor <br /> 4. Make sure all bolts in place on monitor system placement and piping type <br /> 5. Is auto-dial decal on monitor system, if not install <br /> 6. Are turbine sump sensors programmed to High Vapor <br /> 7. Are Prop 65 (Warning) decals in place on dispensers <br /> 8. Are Nozzle Operating Instruction decals in place on dispensers <br /> 9. Are all sump lids bolted? <br /> UN-036-6/6 http://www.unidocs.org Rev.08/22/00 <br />