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2009 09/28 12:11 FAX SJEH lih 0 0.5 <br /> Monthly Insuction -Pase 2 of 2 <br /> PAPERWORK INSPECTION Y N NA Date Done <br /> Monitor'RZ Eystem,certification within gast 12 months) S—zi-If- <br /> Sjill Bucket testing'completed (wiLhin 12ast 12 months) <br /> La&Dc=a==hanicaUIc=aiQ fQ[=at US(alwa Dag 12 oaths) <br /> The above are usually done together on an annual basis far local regulator. <br /> Line"rIffhtnes§Lusual!y u construction or when W'p2sifive shutdown) <br /> Tank 'righLness jusual)y o&after construction or when us!N SIR) <br /> Second 2a containment(SE1989)tests have been completed(usually eveiy 3 M) <br /> -Other tesft or maintenance coMpletedem elow: <br /> b <br /> Test/Maintenance: eEMquir7e ,List th <br /> Test/Maintenance: <br /> Test/Maintenance- <br /> -Comments: <br /> items R29uiring Follow-u 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 must 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 />