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Appendix F-3 <br /> STI SP001 Portable Container Monthly Inspection Checklist <br /> General Inspection Information: ++ ,, p1� <br /> Inspection Date:�}��. Prior Inspection Date: ! kay- Z Retain until date: t <br /> Inspector Name(print): Title: k7 6/11 <br /> Inspector's Signature(): <br /> Container(s) inspected ID ffapgn f <br /> Regulatory facility name and ID number(if applicable) <br /> Inspection Guidance: <br /> ➢ This checklist is intended as a model. Locally developed checklists are acceptable as long as they are substantially equivalent (as applicable). <br /> ➢ This periodic Inspection is intended for monitoring the external condition and its containment structure. This visual inspection does not require a <br /> Certified Inspector. It shall be performed by an owner's inspector who is familiar with the site and can identify changes and developing problems. Note <br /> the non-conformance and corresponding corrective action in the comment section. <br /> ➢ Retain the completed checklists for at least 36 months. <br /> Item Area: Area: Area: Area: <br /> Portable Container Containment/Storage Area <br /> 1 Are all portable container(s)within designated ❑Yes ❑No ❑Yes ❑No ❑Yes EM ❑Yes ❑No <br /> storage area? <br /> 2 Is the containment and storage area free of excess <br /> liquid, debris, cracks or fire hazards? /Yes ❑No ❑Yes ❑No ❑Yes ❑No -]Yes ❑No <br /> 3 Are drain valves closed and in good working /Yes ❑ No 11 N/A ❑Yes ❑ No [I N/A ❑Yes ❑ No ii N/A El Yes ❑ No El N/A <br /> condition? <br /> 4 Are containment egress pathways clear and any <br /> ates/doors operable? Yes C No ❑N/A ❑Yes ❑ No ❑N/A ❑Yes ❑ No ❑N/A ❑Yes ❑ No ❑N/A <br /> Container <br /> 5 Is the container free of leaks? <br /> Note: If"No", identify container and describe Yes ❑No ❑Yes []No ❑Yes No ❑Yes ❑No <br /> leak. <br /> 6 Is the container free of distortions, buckling, ;Yes ❑No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No <br /> dentin or bulging? <br /> Portable Container Checklist Page 1 of 2 <br />