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JUL-12-2005 09:21 FROM:TRACY T K & AUTO S L209E325307 T 640138 P.4 <br /> Designated Underground Storage Tank(UST) Operator <br /> Monthly Vhual Inspection Checklist <br /> Facility Name. -f 2 44-,%4 rP_0(_V_ Date: <br /> Facility Address: -4. CA, %-t b ' t­a_ <br /> Ci Zi 2 Code: <br /> Desig2ated UST Operator Cqndueting the Inspection: <br /> International C delCouncil feTtification#: I Ex !rationDate: L4 4 <br /> Si store: P-ag S r L61-- <br /> Item Y-X5N-_N0,NA=Not A Plicable <br /> -MONUORINGPAN.&L/A HISTORY Y N' NA <br /> I M MEM <br /> onitoring system is powered on and in MSmting mode. <br /> 2 Monitorin stem is -h2ni�alarms or warnifflis_- <br /> 3 Alarm history report/log for the previous month is available,and has been reviewed by the <br /> Designated UST Operator. (Attach <br /> Y-qo <br /> m of the alarm histo repoCqo is ifavailable.) <br /> 4 Each alarm for the previous month has been res E onded to ap .art/lo form <br /> propriately. <br /> 5 Sensors located in containment sumps I ave not alarmed in the 2ast month. <br /> 5a - List all tank-top sumps where alarms occun ed in eke past month: <br /> 'em <br /> 2 <br /> 3 <br /> 4 <br /> 5 <br /> Item <br /> Notc:Sumps where an alarm hoaro=rred in Ow past r tonth m at be inspected unless a qualorted service technician resm-n&4 to,and <br /> Propat,ad*e—d,the cause of the alta m Attach d—meat wi_verifying qTopjak J&,4ce to this report <br /> LEMi coon is"4 recordrandis W ftem 4 WM <br /> TTQ1P Qy,I <br /> H6 Tank-top containment ITEM INSPECTION <br /> t sumps are free 4)f water,d(bris,End hazardous substance. Sensors are locate properly. <br /> 41 Vrmn-al imperwon q&ww, is 0* in swms where n akvm <br /> _T Sum L y N has Occurred In the mw month or which dwm a no service record <br /> > Sum Location: <br /> Sum Location. -sump Location: <br /> S Sum Location: <br /> 'p 10 .. IL <br /> Sump Location: 7- Sump Location: <br /> UP-11!c� Location: Z <br /> 7. . containment are free of r,det and.hazardous substance. <br /> Y W <br /> Tank I-Contents: <br /> T: Tank 3-Contents: <br /> Tank 2-=Contents. I __T <br /> ? Tank 4-Contents:EHEIT 11 .91 <br /> 8 Under-dispenser Containment areas are-free of wal <br /> :Se-r.debris,and hazardous substance. Sensors are I ed EO-Re y. <br /> Dispenser 112 Y N- N-A. 1 Y N NA <br /> Dispenser 9110 <br /> D' eraser 3/4 f Dispenser 11/12 <br /> Dispenser 13 114 <br /> Pj'Menser 7/8 :7rD'11 <br /> I DispenserIS116 <br /> • PAPERWORK lWSP3PCMON Y N NADATE DONE <br /> -9,_ .-MonitaxiDS SXEtcrn certification has been cometc d with W-p&st-12 months, <br /> 10 Second M containment tests have been comeleted within the required timeframe. <br /> I I Sei]J containment structure(bucket)testing was co Rpletvd within the ast ear. <br /> 12 Tank tightness testing was completed within reg2i'Od timeframe. <br /> 13 Line tightness testing was completed within requirt:d timeframe. <br /> 14 <br /> Other re wired testis maintenance was c2MP1eted within reguired timeframe. (List test/maintenance items below. <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> ,ms Nbelow, <br /> Test/Maintenance. T_ <br /> MENIMM <br /> FACILITY EMPLCYEE TRAINING Y NA <br /> 15 All facility,em2l2yees have received thjj2qajMd2 t!Lej- Jb training within the past year. <br /> 16 All facilityem to ---hired within the past 30 davs have j eoeived the reguired on-the-iob trainkin&.�_ <br /> Note: Any answer of"N"should be explained in the coo iment section on the following page,and will require <br /> follovt-up action. <br /> Palm I of 2 September 2004 <br />