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Aug 12 05,07:47a p,2 <br /> t <br /> Site Number: 102 Affordatest Month: June <br /> Designated Underground Storage Tank (UST) Operator <br /> Monthly Visual inspection C eck ist <br /> Facility Name: Love's Fuel Center Date: 42t' <br /> Facility Address:1510 Jack Tone Road <br /> City: Ripon,CA lZip Code:95366 <br /> Designated UST Operalm.Qonduction the Inspection:Janine Kirby <br /> Internatoinale Council Ce afidn :5244224-UC - Ex iration Date: 10/02/2006 <br /> � <br /> Sign atur � Fhone: 530 268-3949 <br /> -- Y=Yes,N=No,NA Not App:ic3bia <br /> Item I RING PANELIALARM HISTORY Y N NIA <br /> 1 Monitoring system is powered on and in properoperating mode. <br /> 2 Monitoring system is not currently showing any alarms or warnings. V <br /> 3 Alarm history report/log for the previous month is available,and has been reviewed by the <br /> Designated LIST O erator. (Attach a copy or the ahem hisioryrapartiog to this form if available.) <br /> 4 Each alarm for the previous month has been responded to appropriately. V <br /> 5 Sensors located in tank-top containment sumps have not alarmed In the past month. <br /> 5a List all tank-top sumps where alarms occurred in the past month: <br /> Note:Sumps where an alarm hes occurred w the pest mont),.must be inspected unless a qua7irred service lechnician responded to, <br /> and property addressed,the cause of the alarm.Attach documentation vrerNying appropirale service to this report. <br /> tr sump inspection)rs mquked,record results in item 6,beiow, <br /> UST SYSTEM INSPECTION <br /> 6 Tank-top containment sumps are free of water, debris,and hazardous substance.Sensors are locatee properly. <br /> Notes Visual inspecOcn of sumps Is only mouk ed in sumps whew an alarm has occurred in the past month for which there is no <br /> service record. <br /> Y N Y N <br /> Sump Location: Sump Location. <br /> Sump Location: 3ump Location: <br /> Sump Location: 3ump Location: <br /> 7 Spill containment structures are free of water,debris,and hazardous substance. <br /> Y N NIA Y N NIA <br /> Tank 1 -Contents-&9 Tank 3-Contents: j it,c `( <br /> Tank 2-Contents:54 ITank 4-Contents.• <br /> 8 Under-dis ensercontainmetn areas are free of water,debris,and hazardous substance.Sensors are located propedy. i-i/I �• <br /> Y N N/A Y N I NIA 1 <br /> Dispenser 7/2Dis enser 9/10 <br /> Dispenser 3/4 Dispenser 11/12 <br /> Dispenser 5/6 Dispenser 13/14 <br /> Dispenser 7/8 Dispenser 15/16 <br /> PAPERWORK INSPECTION Y N N/A DATE DONE T k- <br /> KLine!5 Monitorin stem certification has been completed within past 12 months. <br /> C 10 Seconds containment tests have been completed within the required timeframe. ?� ^� <br /> 11 ' Spill containment structure bucket testingwas completed within the past year. 6S_12 Tank ti htness testin was com leted within required timeframe. <br /> 13 <br /> ti htness testin was com leted within re uired timeframe. <br /> 14 Other required testin I maintenance was completed within required timeframe. List tesUmaintenance items below. <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> Isom <br /> FACILITY EMPLOYEE TRAINING Y <br /> 5 JAII facility employees have received therequired on-the-job training within the past year. <br /> 16 JAII facility employees hired within the past 30 dayse have receved the required on-the-job training. <br /> Note: Any answer of"N"should be explainged In the comment section on the following page, <br /> and will require follow-up action. <br /> Signature <br /> Date /-� /�� <br />