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Designated UndergrOund StOrage T ( Js')Operator <br /> MonNy virual I `on Checklist <br /> Faci s: �`l r r , `• <br /> Ci :S Zi <br /> Des' ted U Cor►du the John Dale <br /> International Erode cation #9000863-UC E - n Date: I�iavensber 24,2d1 I <br /> Si lure: P 916 217-1373 <br /> Y�Y N�NaFl�A�1+ A cab]e <br /> r3ATLanu <br /> MoMrORMG P 1 Y Al NA <br /> nito' is eared ora in r mode. <br /> nitorin em is not or repoat/!og for is , and has been rm by the <br /> DesignatodUST (Attach a o the alarm h' reto this onn i available. <br /> 4 Each alarm for the Wevious month Inas been - <br /> 5 Sensors located m!!2 k t coritamment have not in the past momma. <br /> 58 where alarms occwTed in the past ., <br /> :1'-rJ-Pf' <br /> List a!1 tank-top sumps <br /> Note:Sumps on alarm tors occurred is dne past momh must be inspected mr+less o gtr service leclmtcia» to,/a/nd -{'/.. <br /> properly addressed,doe cause of tie akwm Attach on vats r+$aPProPt"ate se�vlce to rhss rrpm <br /> 1 fn 3s red record result in iter"6,bek7w. <br /> :.:.:..s.:.: <br /> UST SYSTEM INSPECTION <br /> 6 Tatalc tap sana�are free of water,debris,and substance. are located propefly <br /> Plate: sxal i ctiaet sutra is o"1 red in sum where an altos+has occurred im the st month or which there is noYservtceNrecord. <br /> Y N <br /> Sum Location- 91 Sum Location: 87 <br /> Su Location: 89 dation: Diesd <br /> Su7np Location: Surra Location: <br /> Spilt containment structures are free of water, and bazardm m <br /> ---� Y N N <br /> Y N NA A <br /> Tank L-Contents' ,✓ T 3-Contenfs: 87 <br /> T 89 r b Tank 4-Contents: Diesel <br /> ank 2-Contents: <br /> 8 Under - nsa�•containment areas are free of water,debris,and hazardous Sensors are located Irl <br /> Y NA � Y NA <br /> Das r 1/2 Dis 9110 <br /> se <br /> Das ser <br /> 314 Dispenser 11 t 12 <br /> Di enser S/6 D' 13114 <br /> Dispenser 7/8 Dispenser 15/16 <br /> PAPERWORK INSPECTION Y N NA DATE DONE <br /> 9 Monitori stem tion has been c o within 12 months. _X <br /> ��_O <br /> l0 Secondary contliumeW tests have been �wftbin <br /> I 1 Spill contairmnent structure(W&et)tesbug was comp1eted Within the past year. 4 <br /> 12 Ti S testi" was eted <br /> 13 Liaae ti esstesting-2cluted within r aired timeframe. ti (List testlmaintenance items WOW. <br /> l 4 Other fired t Hance was ao luted�vitluut <br /> TesdMaintenance: Leak Deiectton <br /> Test/Mainrenance: <br /> TesWaintemance: <br /> FACILITY EMPLOYEE TIL G Y N NA <br /> 15 All facib em to ees have ieceived the •red on tee-ob - wicituc the car. <br /> I6 Al[facility to hirexl within the 30 da have received the ORAE'lob traiain <br /> » t ' a an the following pages,wad will require <br /> Note: Any answer of"N should be expl - in <br /> follow-up action. <br /> Page 1-of 2 November 2004 <br /> £'d tZZ£-L££-9L6 uyor 8L L:IO 60 50 qe=1 <br />