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MMY-1e-2005 13:58 FROM:TRACY T & AUTO S 12098325307 :4683433 P.19 <br /> P <br /> Designated Underground Storage Tank (UST) Operator <br /> Monthly Visual Inspection Checklist <br /> Faci I i!y Natnu;---- A..Z_6 Date: <br /> Facility Address: <br /> Cit <br /> 'X; :�Zi Code: <br /> Desi aced UST OMralor Conducting the Inspection: <br /> International Cod Council'ICertificatioll#:SCW5cI(dq--�ExpirationDate: <br /> I.-Signature- 1) 1 \11.. 3C Phone: <br /> L Sxa ;6 C)o Q, <br /> ft <br /> I <br /> Y=Yes,N A T Not A pficable <br /> Item IteMONITORING PANEL/ALARM HISTORY y- NA I <br /> em <br /> somas= <br /> I Monitoring sys!S!pis owered on and in proper operating mode. V <br /> 2 Monitorin&sXstem is not currently showinS any alarms or warninn. <br /> 3 1 <br /> Alarm history report/log for the previous month is available,and has been reviewed by the <br /> Desi hated UST 22orator. Attach a copy ofthe alarm histor <br /> ,y repe!VOR to this.fornCifavailable. <br /> 2 <br /> r4 Each alarm for the Previous month has been respnneirmi to ai3propriately. <br /> 5 Sensors located in tank-top containment sumRs have not alarmed in the past month. <br /> 5 5a <br /> a List all tank-top sumps where alarms occurred in the past month., <br /> Note:Sumps where aro alarm has occurred in the parr month must be inspected unless a quatftwservice technkian responded to,and <br /> properly ad*essed,the awe of the alarm Attach d6cwnewtion verifying appropriate service to this report. <br /> Ifsum &a1madan is re :dreg remnlrentu in item 6,below. <br /> MOW. <br /> UST SYSTEM INSPECTION <br /> 6 lank-top containment sumps are free of water,debris,and hazardous substance. Sensors are located properly. <br /> -110PNote:Kswl inwectian Ofsu rs o r d to err where an alarm/tat <br /> w4wred in the pav month or which there is no service recard <br /> Y I N —Y <br /> Sump Location: Sum p Location: <br /> "'/4 <br /> Sum)Location. Sume Location., <br /> Sump Location: Sump Location: 2u <br /> 7 Spill containment structures are free of water,debris,and hazardous suhstance. OT- <br /> Y N NA Y I NF_NA <br /> Tank I-Contents: Tank 3-Contents; ✓ <br /> Y <br /> _AN <br /> (i <br /> Y <br /> V., <br /> Tank 2.. Contents: EE #_ Tank 4-Contents: pz_z <br /> 8 Under-dispenser containment areas are free of water,debris,and hsomrdous substance. Sensors are located Properly. <br /> Y NI NA I <br /> Y : N NA <br /> 2LsL7e=r 1/2 ✓ DisDenser 9/10 <br /> DqLenser 3/4 ✓ DisLenser 11/12 <br /> eraser 516 Dispenser 13 114 41 <br /> I_D' enter 15116 <br /> aenser 718 <br />