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. . <br /> JUL-12-2005 09:22 FROM:TRACY �N�' & AUTO S L209E325307 p'6 <br /> '^ - �, --U ~- <br /> ` ~ <br /> Designated _- __='--_- Storage Tank ^___, Operator <br /> Monthly Visual Inspection Checklist <br /> Facility Address: '1­12 <br /> City: I Zil)Code. <br /> Designated UST Qperator 4?Anducting the Inspection: <br /> Ll _Xf YeLN N21 A Not Applicable <br /> REHM <br /> I Monitoring system is powered on and in p!oper -eratinimode. <br /> 2 Monitoring system is not currently showing any alarms arwarnin <br /> 3 Alarm history reportllog for the previous month it available,and has been reviewed by the <br /> rDesignated UST ORerator. (Attach a copy q(thel larmbistory Me2qjol to thisLorm(favailab e. <br /> 4 Each alarm for the Rrevious month has been res2o ided 0 RRroaiatelX. <br /> 1 Sensors located in ve not alarmed in the 2ast month. <br /> 5a List all tank-top sumps where alarms occurre I in the past month: <br /> Note:SUvWs where an aWm has occurred in thepeut mi nth mm-t be kWected untess a qud#?edservice technician reironded to,—d <br /> properly addresseel the cam of the alarm Attach doememmioa verifying qppreprlate serwce to A&reporl <br /> UST SYS rEMINSPECTION <br /> 6 Tank-top containment sumps are free of water,del-ris,ar d hazardous substance. Sensors are located properly. <br /> 0A -VP'Note Vaual Egecdon 2[snE is only re4qpu, in swnvs 1-here w akm has occw7vd in the Past monthfor which there is no service record <br /> SUM Location: M Loca' <br /> Sump Location: Sump Location: <br /> I Sump Li p Location: <br /> ffislujmL Va", <br /> 7 S2111 —f'Et—-+ijreq are free of water, e i and hazardous substance. <br /> NA N NA <br /> Tank I—Contents.- Tank 3—Contents: b I'EA T-1 <br /> Tank 2—Contents: Tank 4—Contents: <br /> 8 Under-dispenser containment areas are free of wat,.r,debris,and hazardous substance. Sensors are toc properly. <br /> Dispenser 112 Dispenser 9110 <br /> D!�eenser314 Dispenser 11/12 <br /> enser 718 1 Dispenser 15/16 <br /> - 9- -Monitoring Mtem certification has be2!jcomplete iwith <br /> 10 Secondary containment tests have been E2Mplcted !��the required timeframe. <br /> I I Spill containment structure(bucLSjjj!!jjn&Lvas co m3leted within the 12ast year. <br /> 12 Tank tightness testipAwas comRieted within requir�d tim-frame. <br /> 13 Line tightness testing was,comEleted within requir(d timt frame. <br /> 14 Other required testing/maintenance was completed within required timeframe. List testImaintenance items below.) <br /> Jill 111111ijillnElINIFAM <br /> FACILITY EMIPLC�YEE TRAINING f-Yf NINA <br /> lity employees have received.the required o:i-the-i ob training within the east year. <br /> the reguired,onike:W <br /> Note: Any answer of"N"should be explained in the cor.imeni section on the following page,and will require <br /> follow-up action. <br /> Page loJ'2 September 200 <br /> �� . <br />