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Nov 19 07 04: 36p Aff—da Test (20PI 744-0116 p. 6 <br /> Monthl Ins ecttmn - Pia=Je 2 of 2 <br /> N u •r f 3w +' 'i L M?I4 r: '9' m r• ro -It«. <br /> PAPERWORK INSPECTION Y N NA Date Done <br /> Monitoring system certification within past 12 months) "o <br /> S12ill,13ocket testing com.igted within Vast 12 months l' <br /> A )etector-meclianical/clectrouic for mosl sites (witIlin past 12 months) )(A_ )0- 31 <br /> Phe above are usually done together on an annual basis for local regulalor. <br /> Lin- Tightness (usually upon constntction or wllcn n0 positive shutdown 0 A,72 <br /> Tank Tightness (usually only after construction or when using SIR) )O <br /> st!condary containment (SB989) tests knave been-completed (usually every 3 yrs <br /> t ter gestin or maintenance comI)Ieted us required. 1st them . cow: <br /> Test/Maintcnancc: <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> Comments: <br /> 014 <br /> Items Requiring Follow-up Actions: <br /> Monthly inspection must be conducted by an ICC licensed Designated Operator. <br /> A copy of this checklist must be provided to UST owner or operator,but not to State Water Resources. <br /> Designated Operator must alert the UST owner or operator of any condition discovered during the <br /> .montffly inspectidit that may require follow-up aqtione�_ <br /> UST owner or operator must maintain a copy of this'mionthly inspection and any attachments for the <br /> Previous 12 months. Records must be maintabled on-site or, if approved by the local agency, off-site a <br /> a readily available location. <br />