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DCD <br /> � w <br /> Underground Stora (D ° � 5 <br /> �„ �. �'c I'- Storage Tank (UST) Operator (Do N v, <br /> C'�,_,�; t�; ir-�._.t Monthly Visual Inspection Checklist ° o <br /> 73 -4 <br /> -4 <br /> Date: _ ami G' <br /> Zi Code: ° > <br /> in the Ins ection: Ton Fontana w <br /> STEh1 �'L�TUS REF'CiF.'T <br /> ati n #: 1064273-UC Ex iration Date: 05 / 18/2018 K <br /> - - - Phone: 209 )595-4489 tD <br /> LEHK <br /> V=Yes,N=No,NA=Not A gplic O <br /> MONITORING PANEL/ALARM HISTORY Y N N <br /> d on and in proper o eratin mode. m K <br /> rend showing any alarms or warnings. cD <br /> x =• <br /> he previous month is available,and has been reviewed by the (n <br /> Attach a c2a of the alarm history report/logreport/log to this form if available. X <br /> nonth has been responded to appropriately. <br /> ontainment sumps have not alarmed in the past month. C <br /> here alarms occurred in the past month: L—(r �1 A t--I ' SM f 11U� <br /> �Ln1'h1 N I:;T�:,R- REF'C,)<'T <br /> o n <br /> m v <br /> -———— SE NSC.R' HLHRM ----- as occurred in the past month must be inspected unless a qualified service technician responded to,and SZ 0 <br /> I `_!1 STP 1,UMP Jthe alarm.Attach documentation verging appropriate service to this report. D <br /> TP SUMP record results in item 6,below. <br /> E14SCR OUT ALi RH <br /> IHiF 14. 2016 1 :Uy PI1 UST SYSTEM INSPECTION <br /> are free of water,debris,and hazardous substance. Sensors are located properly. A <br /> SENSOR OUT r;L""Rh9 r on required in sumps where an alarm has occurred in the past month or which there is no service record <br /> li;P 14. 20116 11 :58 A111 Y N Y I N o <br /> Sum Location: <br /> EL HL+�RI°1 Q <br /> 14. 2016 11 :56 tihl K Sump Location.- <br /> Sump <br /> ocation.Sum Location: CD <br /> PR <br /> free of water,debris,and hazardous substance. <br /> Y N NA Y N N, <br /> Tank 3-Contents: ' <br /> Tank 4-Contents: <br /> rens are free of water,debris,and hazardous substance. Sensors are located )rope l . <br /> Y N NA Y N N. <br /> Dispenser 9110 <br /> eraser M-A-H, VL I <br /> Dispewer 13/14 <br /> DLWenser 15/16 <br /> $CTION Y N INA DATE DON <br /> 12 months. <br /> dle nlcod timeframe. <br /> dw mg Yrw. <br /> m0. Listtssdmainten nce items below. <br /> CE) <br /> 0 <br /> S'td w o <br /> CL <br /> Iv <br /> Y N N o <br /> (D ob X <br /> 0 <br /> W and WW .Ire o <br /> 0 <br /> r, <br /> w cn <br /> .. o <br /> .rr <br /> 4 <br />