Laserfiche WebLink
Desi ted'Undergro�mif-Storage Tank(UST) Operator <br /> onthiy Visutdins ection Checkli§t <br /> Facili Name: i <br /> Each ; <br /> 'Cl <br /> i Code: ..G <br /> heel amd UST OpwaWConde' the°I eodoa: ' CJ'r dam• <br /> International,Code C i1 Certiflco ®n#rZ2 2 B iratlon hate, / I /v <br /> S slurs: Phone: <br /> Y6.Y N`No. AwNot A ca is <br /> Item MO P L./AX;ARM HISTORY Y N NA. <br /> 1 Monlw ' stem le oW4eed on sOct in r o mods. <br /> 2 Mani stem is not 00==tl .shctwini ast or Warn' <br /> 3 Alarm history rdport/log for the previous month is available,and has been reviewed by the <br /> Deet UST r. Attach a ao a the aJ im hist 're ort/Jo to this orm'i avalJable. <br /> 4 . FAeb alarm for Me vious month has r" tied to. ro riateI , <br /> 3 Sopsors located in tank-tp oontaimatent sum hay—it alarmed nisi tho Past month. ' <br /> sa List all tank-top sumps where alarms occurrsrl m the past month. <br /> Note:.Sumps whem an.alarm has omv sed In di pw moiuh maw be Inwa d uWsss a gue!(/Jed service tachniclan responded to,w <br /> ptoperb+ the arms of dw akya Aapoh law oMMon wroft aMmprlute gervvtce.to Offs report <br /> !� radcord•reaulGs pt.JAah i below. ' <br /> STEM INSPECTION <br /> 6 -top c onWm&nt sdiiips aie Eros afws*debtis,and hazardous substance.:Sensors aro locatedproperly. . .' <br /> oto: <br /> Rama crton !r. ro GMed�ii� Ohara an alarm ha accarred th eke month ar which there!s rso service record' <br /> y N <br /> S ' Location: $MP Location: <br /> Location: ' ' Sunc Gocatton: <br /> 54un Locaalore: 'YM*p Gocatldn: <br /> ..,t. iii eozxt ser°dv�ri au13a +o :'.. <br /> • 7 <br /> Y NA N I lvA <br /> Tank 1.—CoMents::,. Tank 3"Contents: >0 s,R- <br /> 2–Cantsnts: Tank 4w Contents: <br /> 8 Undedis' neer containmeinE 06 of Wa<WAebris and hazardous substance. Sensors aro located ro ori , <br /> Y N -NA Y' 'N NA <br /> D!s sneer 1/2 D1s sneer 9110 <br /> D/s wiser 3/4 Die eraser Il/12 <br /> DJs sneer S/6 Dds ensar 13/14 <br /> 1)!s ettser 7/ DJs 15%16, <br /> 9 Monitonn PAP' INSPECTION <br /> INSPECTION Y ' N NA �DADONEcertification lj .bsoi9�o io wild Min ast,l months.- <br /> 10 Seco containment toots have-boo qq#W@W wilful the Molred thneffame. <br /> 11 ill Containment . wltn he <br /> ou <br /> 12 Tank ti tress tosdn cm I <br /> 13 Lome d loess tee was em law within . ¢rim' <br /> 14 Other r ' red tesiln rnSigtaiiance Was co letad In uirad iitneframe, List test/maintenance items.below <br /> • TesdMalntenance; . <br /> Tsstfuak tenance: <br /> T� Maintetrane:e: <br /> FACILITY EMPLOYEE TRAINING Y NA <br /> 15'[]16 <br /> All facili to [rave reeoived thei ie ottt#�'ob irainin in the vast ear, <br /> All fac li em 1 ass hired within Oho t Mn da hav6 recoived th® utred on-the-'ab trau►in , . <br /> 1!(ots; Any adswar of"Pi"should be explained In the comment seWOn on t e fopowing pate:and will r"ulre <br /> . [Dhow-ap actio®. . � a . <br /> Page 1 of 2 Novomber.2004 <br /> Sd Wdt;,Z:£0 900Z ZO 'OaQ ObSZ TZ£ 9TG: ON Xdd 90NdN91NIdW NOIltilS90IfNDS'z'H: woad <br />