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MAY-13-2008 04:37P FROM: 70:4683433 P.22 <br /> 0 <br /> Designated Underground Storage Tank (UST) Operator <br /> Monthly Visual Inspection Checklist <br /> -Facility -T-V'VCj--_ � I Date:- <br /> FacilFty Address: _19,'40 K) #I- <br /> ci�f. % C'A I Zip Code <br /> -Desig2ated UST Operator Con du-,tinR the Inspection: <br /> International Code Council Certification#: iration Date: 0( /Z-7 <br /> Y-Yjb N-,L4h NA Not A ble <br /> Item MONffOPJNG PANEL/ALARM HISTORY <br /> I Monitoring system is powered on and in ppper operating mode. <br /> 2 Monitoripj system is not 9!genty l X <br /> sh2!�any alarms or warning <br /> 3 Alarm history report/log for the previous month is available,and has been reviewed by the <br /> Desi ted UST Operator. (Attack a copy oZIOM iYavailable.)t <br /> _Lthe alarm histo nearx4oo this <br /> 4 Each alarm for the Rrevious month has been responded to appropriately. <br /> 5 Sensors located in tankto containment RpEps have not alarmed in the 2ast month. <br /> 5a List all tank-top sumps where alarms occurred in the past month: fnea(6. <br /> Arate.Sumps where an alarm has occurred in the past month mug be inspected unless a qualtrwd service technician responded to.and <br /> properly addressed.the cause of the alarm Aftach documentation verifying appropriate service to this report. <br /> 15=don is Madre(4 record r=ulfs in item 6,below. <br /> UST SYSTEM INSPECTION <br /> 6 Tank-top containment sumps are free of water,debris,and hazardous substance. Sensors are located property. <br /> Note.,Visual in on aea din sumps where an alarm has occurred in the past month or which there is no service record. <br /> fEMisonjr aired Y N <br /> Location: Sump Location: <br /> Sump Location: Sum e Location: <br /> Sump Location: Sum Location: <br /> 7 Spill containment structures are free of water,debris,and hazardous substance. <br /> Y I N NA Y I N I NA <br /> LE <br /> Tank I-Contents: V3,4 e.* _k X Tank 3 Contents: <br /> Tank 2-Contents: Tank 4-Contents: t <br /> A , <br /> slkp!ade: <br /> 8 Under-dispenser containtAent areas are flee of water,debris,and hazardous substance. Sensors are located properly. <br /> V I N NA p 4,i --> <br /> Dispenser I/2 Die er 9/10 <br /> Dis user 314 2Lspenser I1/12 <br /> Dispenwr 5/6 9C Dis er 13114 <br /> Dispenser 7/8 PLsRenser 15/16 <br /> PAPERWORK INSPECTION Y NINA DATE DONE <br /> 9 Monitoring system certification has been completed within past 12 months. K 1 3-- to? <br /> 10 Secondary containment tests have been 22m2leted within theEnau:-ed timeframe. 7 <br /> 11 Spill containment structure(bucket <br /> Itestis g was coMRIeted within the 12ast Xear. <br /> 12 Tank ti tress testing was co feted within Leguired timeframe. <br /> 13 Line titress testis was LmEleted within re wired timeframe. <br /> 14 Other aired teLfi�nmaintenance was completed within Muired timeframe. (List test/maintenance itemselow- <br /> TestlMaintenance: <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> FACILITY EMPLOYEE TRAPUNG Y N I NA <br /> 15 All facility 2Mployees have received the required on-the-job training within the past year. X1 I <br /> 16 All facili!X=l2Xees hired within the East 30!Lays have received the Mired on-the-job training. <br /> Note: Any answer of"N"should be explained In the comment section an the following page,and will require <br /> follow-up action. <br /> Page I of 2 November 2004 <br />