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;y UNDERGROUND STORAGE TANK SYSTEM DESIGNATED UST OPERATOR MONTHLYINSPECTION r h acility Name: �� Ll Inspection Date:. _„ y F.tciiit}° Address: city:51 Name of Designated UST Operator Conductillg Inspection: Evangelina Barroso-Traylor lnternatianal `'ode Council Certification No.: 8200889 -UC Expiration Date: 3/10/2019 Si�tlaturc: a "hone: -�— .- r 1 � ' �� ) , � {909} 455-2275 ext. PhR =,.0[11 rar&AA-M Item MONITORING PANEL/ AI:ARM HISTORY Yes! No N/A 1 is Elie onitoringsystern too`+tired on and in proper operating mode? nIs the vn ❑ 3. _arms? Is the Alarm History y l Repoat/log for the pree�n'ous month available, and has it been reviewed by the [� ❑ Desi sated UST O orator? (,I ttach a ct)y of the crlant histor re ort/log to this in,s. ectinn /omit.) j Sump Location: 4 L37�77 the 11 alarm Ibr Xetto appropriately? 6. _ Are spill buckets (otslttaininent struc(ures) free of water,debris, and hazardotw substance? 7 MT -M .e'77727F. e I ank 1 ID - l _ u.si, 4Y*sCNm INSPEV ON S.�Are tank -top containment sumps lie of water, debris, and hazardous substance? Nato: Ifthe answer to hent 4 wav YesIsky, o hear 6. Swnps where an alarm; has occurred in the past month nn+at 5e Inspected i(a quote lad scrviCe rechrnclan has not respanrled I l Uthcr grad tes!in 1 rn uutewl ance was completed w11111 roc cared time It amc'! i1 tri less-luatrtrenance monis h rtr x. j 5e5eribe 1 es RI iunten antic I, ❑ ❑ t)e,rnbc 1 est.'•taEnten�ulc� i RL— FACILITY EMPLOYEE TRAINING Yes I No,j N/rA Ib 11aVe all tacilitv emploleec received the required on-tlae jahfraintnstivitbin the pttit }ear" Ilavc all facility employees hncd tivithin the past 10 days received the ret aired on the joh mannng'? Note: Explain any "No" answers in the "Comments" section on the following page. Those: tssucs require corrective 21 tion from the UST owner/operator. CN -057 - 1/2 ea,vw.unidocs.org 9/26/05 .r,!73- 41, ,/ ir7Aitl sn'ttressM the ce n tP Ue atal/m Uocumenforl nIV" ri rorr0lie1010r°9exltttrrnctittetrthlthFInMisre NJ ' A.... _.� . �,. Yes Yes 1 o Sam Locattou _. _ _ /_ Sum Location. � ty, 1 .Siam Location: Sump Location: 6. _ Are spill buckets (otslttaininent struc(ures) free of water,debris, and hazardotw substance? Yes No N/A Yes No ( N!A I ank 1 ID - l Tank 4 ID - Tanks ID � �] ❑ rank 5 1D ❑ , El-- — flank 3 ID- ( Q 0 1 Tank 615 - ❑ 7, Are under-(Iisl)enser contair»nent areas free orwater, debris, and hazardous substance? Yes No N/A I Yes tallo NIA Dispenser lr'? Dispenser ❑ Dispenser - 3/4 D 11/12 ❑ P Dispenser - 5!6 0Dispenser -- 13t14 Dispenser 7;b - ❑ Dis enser 15/16 -, b — Leak cletection.is )ro))ery located within under -itis rinser containment. Yes No N/A Yes No N/A Die_pmser - 1 /2 iris nscr - 9/10 d _u Dis enser ,; 4 fr-00 w ❑ EI)isiltJtser �._l 12 - - . Dispenser - 5/6 _ ❑ Dispenser - 13/.14 --- - � j_ .-- 1)islacuscr - t h , Dis)enser 15i]6 ,.. - , - PAPERWORK INSPECTION Yes I No N/A Date one t1. Munitonna S- stem Certification was Completed within the past 12 months' 10. Line Leak Detectors were tesied'ccrtified within the past 1 months i � . .. . ' ] 1 will bucket (containnunt ;tnietrr e) testing completed �i ishan the past 12 months_? (�' -❑ `�] � . ILinc ttf htness testing cumPICtcd ceathm the requited time frame? _ i ❑ � ❑ - � g I a Seu7ntlan' contatnmult tcstscontpieted 1»thin the regtnrc�ri time (ratm�?� j-(�9' ja�[' g.. 14 i Enhanced Leak Detection completed Irani:? _ 1_11 ❑ I l Uthcr grad tes!in 1 rn uutewl ance was completed w11111 roc cared time It amc'! i1 tri less-luatrtrenance monis h rtr x. j 5e5eribe 1 es RI iunten antic I, ❑ ❑ t)e,rnbc 1 est.'•taEnten�ulc� i RL— FACILITY EMPLOYEE TRAINING Yes I No,j N/rA Ib 11aVe all tacilitv emploleec received the required on-tlae jahfraintnstivitbin the pttit }ear" Ilavc all facility employees hncd tivithin the past 10 days received the ret aired on the joh mannng'? Note: Explain any "No" answers in the "Comments" section on the following page. Those: tssucs require corrective 21 tion from the UST owner/operator. CN -057 - 1/2 ea,vw.unidocs.org 9/26/05 .r,!73- 41, ,/