COMPLIANCE INFO_FILE 12 - Laserfiche WebLink

Home Browse Search

09/29/05 09:38 FAX 925 422 2748 EPD WGNG Q004 Designated Underground Storage Tank(UST) System Operator Monthly Visual Inspection Checklist S.Jt?,o.() 99.2, Date: /j- -Facility Address: C& n2LI, t 160 -city: r-sl I Zip Code: -Desi&nated UST Operator C6nducting the Inspection: &--f- IJP,' P7 ICC Cert.#: , T71 9,a C- Exp-l)ate: I I/17 / 6 Signature: Phone: 5 qjz -,0 16 C.3 V-Yes,N=No,NA-Not A licable Item# MONITORING PANEL/ALARM HISTORY Y N NA— I Monitorin system is powered on and in proper operating mode. 2 Monitoringsystem.is not currently showing any leak alarms. 3 Alarm history report/log for the previous month is available,and has been reviewed by the Designated UST Ov%erntnr. (Attach a go py ofthe alarm history reI i io _port/log o this ins pect n form 4 Each alarm for the previous month has been responded to approlnLately. 5 Sensors located in tank-to R contaimnent spam s have not ala ed in the past month. 5a List all tank-top sumps where alarms occurred in the past month; Nwxe Note,Sumps where an alarm has occurred in the past month must be Inspected unless a qualified service technician responded to,and properly addressed,the cause of the alarm.Documentation verging appropriate service should be attached to this report. Ksurfig ins ection is reguired,results should be recorded in item 6,below. i -V tIEWO-Y&N-7,77 -, - 7, UST SYSTEM INSPECTION 6 Tank-top containment sumps are free of water,debris,and hazardous substance. L Note: Visual Lns�cdon of sumps Is only re fired in sumps where an alarm has occurred in the past month which there Is no service record Y N y LumLocation: Sum Location: Sump Location: Sum D Location: 7 Spill containment structures are free of water,debris,and hazardous substance. I Y I N I NA I--- Y N NA Tank I -Contents: Tank 3-Contents: Tank 2-Contents: Tank 4-Contents: 8 Under-dispenser containment areas are free of water,debris,and hazardous substance. Y N INA Y N NA D!sRenser 112 k Dispenser 7/8 Dispenser 3 4 X Dispenser 9/10 Dispenser 5 6 A Dispenser 11/12 9 Leak detection is properly located within under-dispenser containment. Y I N NA YJ N NA Dispenser 1 2 X Dispenser 7/8 Dispenser 3 4 X Dis er A, p 9110 Dispenser 5 6 Di enser 11/12 AW,MM-773,77,77 'r, IW PAPERWORK INSPECTIONY I N INA DATE DONE 10 Monitoring system certification has been completed within past 12 months. g.6-6Gf- 11 Sec2ncontainment tests have been completed within the required timeframe. .2/. of/ 12 Spill containment structure(bucket)testing was c"m feted within the past 12 months. 13 Tank ti htness testing was co feted within required timeframe. 14 Line tightness testing was completed within requirgd timeframe. 15 Other ESqu :ired tesLin �maintcnancc was completed within required timeframe. aistlest/maintenance items below. Test/Maintenance. I I L I Test/Maintenance: Test/Maintenance: FACILITY EMPLOYEE TRAINING Y N NA =facility employees have received the r!�xLuired on-the-job training within the past year. All 17 All fac hired within the past 30 dM have received the required on-the-'�traininjz- J" Note: Any answer of"N" should be ex-plained in the conanent section on the following page,and will require follow-up action from the UST owner/operator. Page I of 2