COMPLIANCE INFO_FILE 12 - Laserfiche WebLink

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09/29/05 09:39 FAX 925 422 2748 EPD / WGMG 0006 Designated Underground Storage Tank(UST) System Operator Monthly Visual Inspection Cheeldist Facili!y N J,,t A1,4_ S,-k ,�--n gg,2, I Date: ya 2 Z6-4 Facility Address: Cit y: c- I zip code: Designated UST Operator Conducting the Inspection: !� _ -IGC Cert.#: CC— C_ E*.Date: W 106 S' name Lf Phone: C2 Y=Yes.N m No NA-Not Ucable Item# MONITORING PANEL/ALARM HISTORY Y N NA W Ef ME, Mvt -R V-777 ;; 7727, V= Z 1 Monitoring system is powered on and in proper operating mode. 2 Monitoring gstem.is not currently showing an leak alarms. 3 Alarm history report/log for the previous month is available,and has been reviewed by the Designated UST Operator. Attach a copy ofthe alarm histo g re ort/to-to this inspection 4 Each alarm for the previous month has been responded to appropriately. 5 Sensors located in tank-top containment sums have not alarmed in the past month. 5a List all tank-top sumps where alarms occurred in the past month: 4- Note:Sumps where an alarm has occurred In the past month must be inspected unless a qualified service technician responded to, rid properly addressed,the cause of the alarm.Documentation ver6ing appropriate set-vice should be attached to this report. -Ifsump inspection is re uired,results should be recorded in item 6,below. T RM-4 .A- ............. OR.- IM 7 1 n"05, 'TTRUM_071�makS. UST SYSTEM INSPECTION 6 Tank-top containment sumps are free of water,debris,and hazardous substance. -*Note;Visual inspection gsum p;is Only re uired in sumps where an alarm has occurred in the po month f or which there is no servicerecord 'ff Y N Z.4 Y N 0. Sump Location: Sump Location: Sump Location: Sump Location: �+ v 7 Spill containment structures are free o£water debris,and hazardous substance. Y I N NA I ftY 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. N I NA Y N NA Dispenser I/2 Dispenser 718 Dispenser 3/4 Dispenser 9/10 Diseenser 5/6 DisEenser 11/12 9 Leak detection is properly located within under-disl wuser containment. Y N NA Y N NA Dispenser I/2 Dispenser 7/8 Dispenser 3/4 Abspenser 9/10 F-Dispenser 5/6 Dispenser 11/12 ZATM R�I _FM PAPERWORK INSPECTION Y N NA DATE DONE 10 Monitoring system certification has been c2pMleted within past 12 months. 4 1G 11 Seco pdM containment tests have been completed within the required timeframe.I Spill containment structure{bucket testing was completedwithin the past 12 months. ,,/a - 4 13 Tank tiWitness tfiner was rev reqLtred timeframe. Y, 1 0 2 3 14 Line tiphtness testing was completed within re timeframe. 15 Other required test maintenance was completed within required timeframe. (List testlmaintenance items below.) Test/Maintenance: Test/Maintenance: Test/Maintenance: FACILITY OYEE TRAINING Y _N I NA 16 All facility eM2lo)Ms have received the re(D fired on-the-job training within the past year. 17 A11 facili Mployees hired within the East 30!Lan have received the required on-thej Note: Any answer of"N"should be explained in the comment section on the following page,and will require follow-up action from the UST owner/operator. Page 1 of 2