Laserfiche WebLink
r y <br /> M <br /> w <br /> O <br /> M ---�Sde Number MWoth <br /> M <br /> ti N <br /> tT <br /> c° DeOgn Cited Underground Storage Tank (UST) operator li <br /> oMonthly Visual Ins ction Checklist <br /> W 5 nature sNr6lair Gate _ <br /> tl M <br /> facd Address 1001!YurMsraNe .---~---_.. <br /> D 1k 1111814 ce Zip Code 68336 _. <br /> -a 0 , mated UST f rator GonduPw c ^tion the inspection Randall Kirby <br /> fnte<nattanal Code Jaunt i C,erldiration 0 $250568-UC Ex frahon Date 12/0312017 <br /> O �a <br /> N = 5, nature ;;.', d Phone,j918i 870-5432 <br /> Wd � <br /> r— •^ r•rax.ra,rae: +va¢avrA,r ,asa. <br /> item Y I N MSA <br /> CV <br /> M drt and!rtIV <br /> 2 i is#t}Kou'rrentt r;howm arty atarr,fs arwamtn s <br /> 3 AtsM t reRortilog for the previous month is available,and has been reviewed by the <br /> C T Operator fAharh a col.! nF Mn arram hrsfo re t4 this form d evaulabte Aga <br /> N 4 Each the feylous month has been responded to a2propriiatety, <br /> t3 5 Sonsbalmamlkd in fink-fnD containment sumps have not alarmed in the past month <br /> Lit-. ..top sump,*where alarms occurred in the past month: <br /> Co <br /> Q <br /> u) NM-Sumps where an&farm has occurred rn the past month must be inspected unless a qualdJsd br xe tsChnruen responded to. <br /> - avrOA 10 P fly addressed,the cause of the alarm.Attach documentation verifying appropirate 3erwe to this report. <br /> O Mw+e{pprspecbordu required,rewrd results in ream&,below, <br /> a:+ <br /> U UST SYSTEM INSPECTION <br /> 8 Taf*Aop containment sumps are free of water,debris,and hazardous substance.Sensors aro located property <br /> UAwe V,ue/inspection of sumps is only required in rumps where an alarm has occurred in the post month for wroth there is no <br /> serwce record <br /> E Y N Y N <br /> Sump Location Sump Location: <br /> N Sump Location Sump Location <br /> Sum Location- Suntp,Location: aj <br /> c 7 $ ftf containment structures ate free of water,debris,and hazardous substance. <br /> -- <br /> 0 Y N N/A Y N NtA <br /> Tank t• Contents'87 Tank 3-Contents:Diesel <br /> o Tank 2•Contents;Si 1 ITank 4-Contents. i 1j <br /> X <br /> E under-dispensercontainnmetn areas are free of water,debris,and hazardous substance.Sensors are located Pr <br /> N <br /> Y N N/A Y <br /> 112 Y 2LSpenser 9 f 10 <br /> o ✓/5 enser 3/4 w `y Dispenser 11/12 <br /> Z GlsLien er 5 t 6 Dispenser 13!14 <br /> r.. <br /> Dispenser 15116 <br /> D <br /> Y RK INSPECTION Y N <br /> U , <br /> 0 9 Mon4aring system can't en com k+ted within ast 12 months X <br /> U 10 <br /> en completed within the required timeframe. X <br /> M o sting was completed within the past year. X i17tM12016 <br /> 12 ed within r uifed timeframe <br /> rn 13 Line tight a ted wtthin required tmWrsme. <br /> U14 tDtirer t uired tesitn nce was completed within required t <br /> ` a TsWMs/nlsnsnca+r <br /> o - <br /> 1° Ts�/Ms/npnsncs_ Y <br /> ar Tsa!/Mainlanance of 212015 <br /> O to <br /> CACi!J EMPLOYEE ar <br /> N U) ---. c <br /> D16 f4ll tacAAaUMY emolo herb r*(?ttvrrd the required on-theto <br /> o <br /> 18 AN lscilfl em to ,ttM►s hin tart fist 36 da a haver F- <br /> Q Nolte' Any answer of"N"should ba sxpiainged in the comment U) <br /> and will require toliow. W <br /> •O N <br /> N <br /> O <br /> } C) N Q <br /> N C <br /> C) CA U <br /> O M a �0 <br />