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DosiSria,ted-'Undergrou>f&Storaie 'T (US•T)Operator . <br /> MoAthly Vieption Khoo i t <br /> FAoili Name: ,+ '�" Date: <br /> :ft oilltyAddrdss <br /> Ci Z Code: <br /> Desi ted UST t9 ator Conduct' ' 'the:dne ectlon: <br /> Intprnatignal Code Council Cert o tion#a' C- iriation pate:' ' / MIT <br /> 5iI•Phos®: <br /> 1 <br /> Ti�Ye N r IV NA Not A mblo <br /> t2, <br /> MON t?JteIi�i VANI ./AI:ARMI RIt4TQ�tY' Y .N NA <br /> modeMoni n -s stow is�iot''obrmntl , hdw9 ' mms or warnin s,Alarm hlstory report/log for the previous-month is available,and has been reviewed by the <br /> Desi J IS Q motor, (Attaah p co o the al htstd ''re orlllo to this orar'! avafla8le. <br /> 4 •Bach alarm for the previous month}gas been're nM to to ri to , o` <br /> S Sensors located isi,tank•to contaiasmcnt sura s .jot alarmed 1ii,tho pist month,' <br /> 5a List-all tank-fop comps W her a elm ms•pvcutre� it the pps4 march: _ �... _-- <br /> ' ' Noui.SrrmpJ whets an,alarm Aar»coerrFed fn the pant rrroblh mart bs Inrpeotsd rrrrlsaG9 a garat{/Ted serulcs tschnlctan responded to.aied • <br /> properly addre md,the carate,,4f the d(arm,s(Maah doamrtenurdon vsrilWrrg etp rOprlats iervtcs to they repor!. <br /> a&nr etlon 1d ra rllrkd record•reslrlla ln.11em.e,l*elaie, <br /> ' , '$Y$T�MIN 13�'iUN • <br /> 6 'Tank-to'p c6ntai �qt sAihp's'Wre frr&•Orr*Wr,¢ebflls,sell ho&dous subitanoe.'Sensors-are located proporly, <br /> ole:YiWal I ectlon /s a rd trod i t► ro analarm lets ooa amd in the t sr mh or AIM there!e ho Prylve reaerd' <br /> ' Sum LOClit�on: M1 .X: . .S�rnfJ LCCA 1®n: N <br /> Sum Ldcalloa; S Locatdoit: <br /> ' Sura Locullort: S'�t1'1 LocaTton: <br /> - 7 eY ", tobri 1c,0_G - clt.g ee.oWe ,aad;h s at�b oa. <br /> N <br /> Tahk 1-Contents: , T •3 r•Contents' <br /> Tank.2_Canteho: ;. Tank 4--Contdnu <br /> 8 Under-dis,onset coptei ent ai eas 4 i�ee'tf Wst"'' ebrls'and hazardous substance, Sensors are-10 ted o rl . <br /> y ' ly' :NA Y N 'NA <br /> Dts eraser 1/!l D/ eraser'9/10 <br /> Als eraser 3 Y 4 Dls etlmdr 11/12 <br /> Dls a er S/d ,Dls enm&13,/14 <br /> .D ewer?/a <br /> I I I - �11 . D&Preftser 15116 <br /> PAPE WORK INSIVOW Y N NA DA'Z'E DONE <br /> 19 Moaiton tern certifica io 'has:boe�ro letedrwitlt�tti asf I2 months..'. <br /> 10 Socondary containment'tests have bemn coftlete'dwithIA the regulred timoftavill <br /> 11• S `Il containments c u e s ' Com eted withinbe ast' dar,• <br /> I2' Tank tness testing wasQO leted•vrithl •re d efratsse. <br /> 13' Line tightness tostiri .was cpm feted within re k tltn' e: <br /> 1,4 Offer re"aired testi» mainfei tanoo was torhiolitid within ro uired.timeEmme. Lest test/malrztenance/gems below <br /> an Ce.," <br /> TP,st/Ma1n1stlance;' ' <br /> 7'esllMal t4nance: ' <br /> 1rACILiTY>EIYIpt,Q , E' IN Y N -1 NA <br /> I S" <br /> 11 facili eni to ee have received there ulrectroK-tha-ob trainin ithtn tho pastyou! <br /> I6 AWfacili em to ees hired within the Diist 30 t have s the uirvd,on-tha'ob traittir� ; ' <br /> >Kote3 4y atiswer of"N"•should be explained In the coulmont sectiolmbn the foU9*i4g page,and will require - <br /> :., follow-up action, ; <br /> fgel oft' Novomber2004 <br /> 6d WcM:£0 S00Z ZO 'oa(I ObSZ TL2 9TG: 'ON XUA 33NdN31NIdW NOIld1S90Ind3S'Z'8: WOdA <br />