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Nov 29 06 03:20p Rfforda Test [2091 ^44-0116 p.3 <br />Month1v Inspection - Page 2 of 2 <br />PAPERWORK INSPECTION Y N M Date Done <br />Monitoring system certification (within past 12 months) 0 -JI vi <br />ill Bucket testin , corn letedJ within past 12 onths x' ell -s+ u <br />'!'he above are nsualfv done loxcllTer or an annual hayhl .dor local rcgulalor. <br />Line Tightness(usually upon construction or when no pasitive shutdown <br />Tank Tightness (uswily only after construction or when using SIR <br />Secondary containment (SB989) tests have been completed usually every 3 yrs1 n <br />Other 14'.vtinfir or muintt nunce cumruqltLrqd. fist them he vw: <br />Test/Maintmance: /j��� ! <br />"I'ost/Maintenance: IY <br />Tcst/Maintemance: <br />Comments: <br />Items Re uirin T Follow -!!2 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 />monthly inspection that may require follow-up action. <br />UST owner or operator roust maintain a copy of this monthly inspection and any attachments for the <br />previous 12 months. Records must be maintained on-site or, if approved by the local agency, off-site at <br />a readily available location. <br />