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05/13/2009 ti;1: 42 2098870198 KAREN ARNAIZ PAGE 01 <br />Designated Underground Storage Tank (UST) Operator MAy 1 5 2009 <br />Monthly Visual Inspection Checklist <br />Facility Name: Arco <br />Date: 05/29/08 <br />Facility Address: 16 E Harding <br />PERMITISERVICES— <br />City: Stockton <br />Zip Code:95304 <br />Designated UST Operator Conduct' g the Inspection: Karen It Arnaiz <br />Monitonng system is powered on and in proper operating mode.X <br />Monitorin system is not currentlyshowingany alarms or warnings. -_ <br />International ode Council ertification #: 5266643 -UC <br />_ <br />Expiration Date: 07/16/09 <br />Signature <br />Phone:( 209 ) 518-4836 <br />r r y-rvr -o- i r - - -- - \ 1� <br />Y = VPS. N = No. NA = Not AnnJaM IP <br />Item <br />M@NTORING PANEL/ ALARM HISTORY <br />Y I N NA <br />1 <br />Monitonng system is powered on and in proper operating mode.X <br />Monitorin system is not currentlyshowingany alarms or warnings. -_ <br />X <br />2 <br />3 <br />Alarm history report/log for the previous month is available, and has been reviewed by the <br />Designated UST Operator. (Attach a co o the alar rot history re nrt/In to this i 'available.) <br />X <br />4 <br />Each alarm for the previous month has been responded to appropriately, <br />X <br />5 <br />Sensors located in tank -top containment sumps have not alarmed in the past month. <br />X <br />5a <br />_ List all tank -tap sumps where alarms oceut-red in the past month: <br />Now Sumps iekere on alarm has occurred in the past month must be inspected wdess a quafiJIed service technician responded to, and <br />properly addressed, the cause of the alarm, Attach documentation verhyng appropriate service to this report. <br />ffsumo inspection is required, record results in hang 6, below. <br />UST SYSTEM INSPECTION <br />6 <br />Tank -tap containment sumps are free of water, debris, and hazardous substance. Sensors are located property. <br />No+re: Visual inspection a(stmtps is o4y re uired in sumps a kere ant alarm has occurred m thepast mowhibr which there is no service record. <br />Y N <br />JY <br />N <br />&(mp Locations: X <br />Sump Location: <br />X <br />- <br />- <br />Sump Location: X <br />Sump Location: X <br />7 <br />Spill containment structures are free of water, debris, and hazardous substance. <br />Y <br />N <br />NA <br />Y N NA <br />Tank I - Contents: 87 <br />X <br />Tank 3 - Contents: 89 <br />X <br />Tank 2 - Contents: 91 <br />X <br />8 <br />Under -dispenser containment areas are free of water, debris, and hazardous substance. Sensors are located properly. <br />Y N- NA <br />Y N NA <br />Dis enser 1/ 2 X Dis ser 9110 <br />X <br />Dis nser 3 / 4 X <br />Dispenser 5 / 6 X - <br />Dispenser 7 / 8 X y - <br />PAPERWORK INSPECTION Y N NA <br />DATE DONE <br />9 <br />_ <br />Monitoring system certification has been completed within past 12 months. X <br />05107/08 <br />10 <br />Secondary containment tests have been completed within the required timeframe. X <br />10/18/07 <br />1 l <br />Spill containment structure (bucket) testing was completed within the past yew. X <br />05107/019 <br />12 <br />Tank tightness testing was completed within required timefratne. X <br />0l/105 <br />13 <br />Line tightness testing was completed within required timeframe. X 1 <br />01/05 <br />14 <br />Other required testinghnaintenancc was completed within r ired timeframe. (List test/mainlenance items below. <br />Test/Maintenance: <br />Test/Maintenance: <br />TestlMaintenance: <br />FACILITY EMPLOYEE TRAINING <br />Y N NA <br />15 <br />All facility crn to ees have received the required oii-the-'ob training within the past year. <br />X <br />16 A <br />All facility employees hired within the past 30 days have received the rewired on-theJob training. <br />X <br />Note: Any answer of "N" should be explained in the comment section on the following page, and will require <br />follow-up action. <br />Page I of 2 November 2004 <br />