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tD <br /> (D s? <br /> N tV Con Je rground Storage Tank(UST) <br /> Operator <br /> O �cn Zl r:tlil� Visual inspection <br /> Checklist <br /> Sv t� it �,,,,, shell Date: 11/21/13 <br /> p - <br /> w Q t:�.,r;r, .t,+,tress:7700 Morelmtd(t <br /> �{h;_CIO�hIUnnem <n <br /> O Q0 <br /> lksi ted UST O tarot Conducting the Inspection:Kann R Arnatz _ ^ <br /> u) CSD Internatiorml ode Council Ce ification 8032295-UC Ex iration Date: 05131/IS V J <br /> Si 't� - Phone 2 - <br /> ( 09) <br /> -D o T ti'-yam n=. .. <br /> Q Item! MO ' ING PANEL/ALARM HISTORY <br /> 10 WA=NDIA (ir Llr <br /> DQ - r <br /> I Monitoring system is Y Nwered on and in proper o ratio mode. - <br /> 0 _ Monitoring system is not currently showing any alarms or warrifirlIps. X <br /> Alarm history report/log for the previous month is available,and has been reviewed by the <br /> x <br /> O Designated USTerator. (Attach a co i'o!the alarm hision're ort/lo to this jnrm ijcnuiluble.) X <br /> O 4 Each alarm for the previous month has been resp2nded to appropriate] <br /> 0 <br /> 5 Sensors located in tank-to containment sumps have not alarmed in the past month. X <br /> v X O <br /> CD 5a _ List a!1 tmt,E-tap sumps where alarms occurred in the past ntatth <br /> Sv � <br /> O <br /> =3Vote:Sumps ndrere me alarm has occurredin the past mor ,amust!n inspected unless a qualified senrce tec, rmrnicrespotukd ro.a d.--r rope rh m1dressed•the cause ojthe alarm.Attach documentation vertfiing oppropriale servke to this report O <br /> =7' Ipjsum ins dm ieis required record remr,,,,,n <br /> (D <br /> )1 E11 INSPECTION <br /> 6 Tank-top containment sumps are free of r,debris,and hazardous substance. Sensors are located properh. <br /> N S'otr.'Visual ins •coon ojsumps is wrh re acre;: ,err s irlr�'re an atnrrn tau occurred ur the est month for ulrrch tlrerr a no sen•rct record <br /> N Y N <br /> W Surrip Location:87 Fill X Sunt Locution:87 Turbine X <br /> Q Sump Location: 91 Fill X Sump Location: 91 Turbine X <br /> O Sum Location:Diesel Fill X Sunt n Loc-atimu Diesel Turbine X . ^ <br /> U) <br /> lJ J <br /> 7 Spill containment structures are free of water,debris•and hazardous substance. <br /> Y N NA V N NA r� <br /> cD Tank I-Contents:87 X Tank 3-Contents:Diesel X <br /> Q Tank 2-Conlents: 91 1 X <br /> O 8 Under-dispenser containment areas are free of water,debris,and hazardous substance. Sensors are located rorh �f <br /> (�D Y N NA Y N - O <br /> Sv <br /> Dispenser i/2 X - n <br /> p Dispenser 3/a X <br /> -Dispenser S/6 X <br /> ODis Dispenser 7I 8 X O <br /> � _ i <br /> O V N NA D:%JI Ut)\f <br /> PAPERWORK INSPECTIOND <br /> r* 9 Monitoringsystem certification has been completed within ast 12 months. X US <br /> 10 Secondary containment tests have been completed within the re uired timeframe. X — <br /> � 08129!!3 <br /> ar I I S ill containment structure(bucket)testingwas completed within the as[ 'ear. X \ J <br /> 0_ 12 "rank ti:thtness testin was com feted within required timeframe. <br /> O 13 Line tightness testin was com feted within required timeframe. <br /> 73 14 Other required testin maintenance was completed within re uired timeframe• (List test/maintenunce items'hcfati+cl <br /> -U (n Test/Afairitertance: n <br /> Test:hfaintenance. <br /> � 1 V <br /> O TesNAfairtenmtce. Y N NA <br /> FACILITY EMPLOYEE TRAINING <br /> 15 All facility ern tloyces have received the required on-the-iob tminina within the est veer•02.n_g%I _ \ i <br /> � tp :fit' 16 All facility employees hired within the .cu�,u da s have received the require�t'"�h1) ge and require <br /> O to ff'''' Note: Any answer of"N"should be explained in the Coll] section on the(0110%%in <br /> page•and«ill <br /> p .`C # follow-up action. <br /> 00 e: <br /> N � r <br /> CTI (D <br /> Page 1 of 2 <br />