COMPLIANCE INFO_1996-2006 - Laserfiche WebLink

Home Browse Search

UNDERGROUND STORAGE TANK SYSTEM DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT Facility Name: L , h J �. I I Inspection Date: \2 l Facility Address: ��Q G�W G1 qty' Name of Designated UST Operator Conducting Inspection: C y,�CAi International Code Council Certification No.: ly C Expiration Date: Signature: f Phone: ("y4k4-S1I$ ext. NIA—Not As pHoAdb Item MONITORING PANEL/ALARM HISTORY YesNo N/A 1. Is the monitoring powered on and in proper operatingmode? 2. Is the monitoring stem not currently any leak alarms? 3. Is the Alarm History Report/log for the previous month available,and has it been reviewed by the Designated UST tor? Attach a copy ofthe alarm hiwory!Vortfiog to this ' ection o-ML 4. Has each alarm for the 'ous month been to a atel . El UST SYSTEM INSPECTION 5. Are tank-top containment sumps free of water,debris,and hazardous substance? Note_Ijthe answer to Item 4 was-Yes,^slip to Item 6.Sumps where an alarm has oeearred in the Past month must be inspected ja quaiied service technician has not responded to,and property addressed the cause 4Ae alar.Documentation veri Wag gowwHate service should be attached to this report Yes No Yes I No Sump Location• IWO structures free S Location: S Location: S Location: El6. Are 'll buckets containment of water,debris,and hazardous substance? Yes No NIA Yes No N/A Tank 1 ID— Tank 4 ID— I F1 I El Tank 2 ID— Tank 5 ID— ❑ Tank 3 ID— Tank 6 ID- 7. Are under-dispenser containment areas free of water,debris,and hazardous substance? Yes No N/A Yes No N/A Dispenser—1/2 Ljj Dis —9/10 F1 I El I [l Dispenser—3/4 LJ Dispenser—11/12 El n Dispenser—5/6 Di —13/14 ❑ ❑ Dispenser—7/8 Dispenser—15/16 ❑ 8. Leak detection is properly located within under-dispenser containment Yes No N/A Yes I No N/A Dispenser—1/2 Dispenser—9/10 01 F1 Di —3/4 Di ser-11/12 0 111 ❑ Di —5/6 —13114 01 [] Di ser—7/8 Di —15/16 ._:: . PAPERWORK INSPECTION Yes No N/A Date Done 9. MonitoringS Certification was completed within the 12 months? 1:110. Line Leak Detectors were tested/certified within the 12 months? ❑ El11. Spill bucket containment structure testis completed within the 12 months? 1 El 12. -Line tightness testing completed within the required time frame? ❑ 13. Secondary containment tests completed within the required time frame? ❑ 14. Enhanced Leak Detection completed within the required time frame? 15. Other required testis maintenance was completed within required time frame? List test/maintenance items i5elow. Describe Test/Maintenance: Describe Test/Maintenance: ❑ ❑ FACILITY EMPLOYEE TRAIMNG Yes No I N/A 16. Have all facility 1 received the required on-the-job training within the past year? 17. Have all facie' 21!Mees hired within the 30 d=received the uired on-the-'ob trainin .? Note: Explain any"No"answers in the"Comments"section on the following page.Those issues require corrective action from the UST owner/operator. UN-057-1/2 wwvw unidemerg 9/26/05