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JUL-12-2005 09:20 FROM:TRACY K & AUTO S L209E325307 TjW6410138 P.2 <br /> Designated Underground Storage Tank ('UST) Operator <br /> Monthly Vist al Ir.spection Checklist I <br /> Facility Name: 7-Tr-K -b I Date: <br /> Facili!X Address- g I V 0 r 4;67 7;T_V_6 <br /> C!tl: 7_4A-e_T1 6 A- I Zi v Code: E* <br /> Designated UST Operator Conducting the Jnspection: <br /> International ode (Rr.tification#: -SZ-g5,1 <br /> Signature: V . -1 <br /> U <br /> Y=Yes,N=IN40%,NA=Not A pkabl <br /> Item MONITORING)'ANE L ALARM HISTORY _y N <br /> Item <br /> 1111111 <br /> NA <br /> Monitoring stem is Powered on and in p!o <br /> I _per ol ceratin mode, <br /> r2 Monitoring system is not currently showing any 2[arms or warnings. <br /> 3 Alarm history report/log for the previous month i: available,and has been reviewed by the <br /> Designated USTOPcrator. (Attach gSoMpfthe i larm idstoryaEort/lo gtothis Lorm ifavailable.) <br /> 4 Each alarm for the Previous month has been respo Ided t 3 appropriately. <br /> 5 Sen-sors located in tank-top containment sumRs hf ve not alarmed in the past month. <br /> Sa List all tank-top sumps where alarms occurredin the past month: <br /> Note:Sumps where an alarm has occurred in the part m,nth mu-i be inspected unless a qualified service technician responded to,and <br /> properly addressed the come of the alarm.Attach docut ii i vera, te service this report.6*zg aMmprfa ce to <br /> I sumP b1spection#rFqu&r4 record results in item 6,b-law. <br /> MONESEEM I I '' ' ;B:iaiiiim <br /> UST SYS rEM.WSPECTION <br /> [t6tTank-top containment sumps are free of water,del iris,as d hazardous substance. Sensors are located properly. <br /> -Katie:Visual Lono suom is o* - in sumps vhere w,alarm has occurred in the2ILt month for which there is no service record <br /> _ . TN Al <br /> Sump Location: V / u�' SUM Location: <br /> Sum Location: 71— — <br /> Sump Location: c 771 Sump Location: <br /> I Sump Location: <br /> 7 Spill containment structures are free of water,deb is,and hazardous substance. <br /> V_1V 9 _NA f Y T N hiA <br /> Tank I Contents: Tank 3-Contents: ell <br /> Tank 2-Contents: Tank 4-Contents: D :Z <br /> 8 Under-dispenser containment areas are free of wat,.r debris,and hazardous substance. Sensors are located properly. <br /> Y-- N ! NA Y N <br /> Dispenser 112 <br /> Dispenser 9110 <br /> is enser 3 4 <br /> Dispenser 11/12 <br /> DisRenser 5 6 Dispenser 13/14 <br /> D22eniser 718 Dispenser 15 116 <br /> PAPERWORK NSPECTION Y N NA DATE DONE <br /> 9 ., Monitoring system certification has been complete J with in east 12 months. "I <br /> 10 Secondary containment tests have been E2TIfeted-!�ithjn the required timeframe. <br /> I 5Rill containment structure(bucket)testing was co:npleted within the past year. <br /> Ih12 Tank tigtness testing was completed within requir-d tim!fiame. <br /> 13 Line titn ess testing was completed within requirt d time frame. <br /> 14 Other re aired testing/maintenance was com2leted within m <br /> a t test/maintenancethw.) <br /> quired timeframe is items be <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> I <br /> Test/Maintenance: <br /> FACILITY EMEPLC YEE TRAINING <br /> Lt <br /> XY <br /> NA <br /> A facili emel2yees have received the Muired oj ii-the-i A training within the past year. <br /> 16 All faciliV emel2XSqLhired within the Past 30 4a s.have jeceived the required on-the=ob b-dinin- <br /> Note: Any answer of"N"should be explained in the con iment section on the following page,and will require <br /> follow-up action. <br /> Pa;e I of 2 September 2004 <br />