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APPENDIX r ' r ' MONTHLY UNDERGROUND STORAGE SYSTEM INSPECTION <br /> Go to wIw.peLorg1RP900 for an electronic version of this form. <br /> MONTHLY UST SYSTEM INSPECTION CHECKLIST <br /> Facility ID# Facility Name/Address Level II Qualified Person Signature Date <br /> If any problem is found, contact: Contact information: <br /> Category Description PURP000 WA Tai Tai Tatic3 Tark4 <br /> Operator Training Review site training documents 7.4 <br /> Daily Inspections Complete daily checklist and compare to previously completed daily 7.5.1 <br /> checklists <br /> Leak Detection Circle method of tank leak detection: ATG, CIM, SIR, IC, GWM, SVM, IMT 76 <br /> Recordkee i Circle method of piping leak detection: CIM,Ii SIR, GWM, SVM MIMP <br /> Automatic Tank Gauge(ATG) Passing tank test report printed and properly filed 7.6.1 A <br /> Continuous Interstitial Monitoring Sensor status report printed and properly filed 7.6.2.1 <br /> CIM <br /> Monthly Piping Leak Test(MPLT) Passing piping leak test report printed/documented and properly filed 7.6.3.1 <br /> Statistical Inventory Last month's SIR results passed and available for inspection 7.6.4.1 <br /> Reconciliation SIR <br /> Inventory Control(IC) Inventory reconciled and within the company or regulatory standard 7.6.5.1 <br /> Manual Groundwater Monitoring Groundwater bailer in good condition 7.6.6.1 <br /> GVuM <br /> Manual Groundwater(GWM)or Wells sampled and results pass 7.6.6.2 <br /> Soil Vapor Monitoring SVM <br /> Steel tank: interstitial space checked and found dry 7.6.7.1 <br /> Manual Interstitial Monitoring Fiberglass tank:interstitial space checked and found dry 7.6.7.2 <br /> for Tanks(MIMT) Fiberglass tank:level of monitoring fluid within normal range 7.6.7.3 <br /> For steel and fiber lass tanks vacuum level is within tolerances 7.6.7.4 <br /> Tnk 1 vac: Tnk 2 vac: Tnk 3 vac ITnk 4 vac: <br /> Manual Interstitial Monitoring Containment sump(STP and/or remote fill sump)inspected and no liquid 7.6.8.1 <br /> for Piping MIMP) found <br /> All Tanks 7.7 <br /> Spill Kit All components of the spill kit are present and in good condition 7.7.1 <br /> Grade-Level Covers All covers present,in good condition,seated firmly on the correct tank 7.7.2.1 <br /> Drain valve in spill containment manhole in good condition 7.7.3.1 <br /> Spill Containment Manhole <br /> Interstitial space of double-walled containment manhole Is dry 7.7.3.2 <br />