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612 S. Cherokee Ln, Lodi, CA 95240 Record ID PR0521866 <br /> 10/25/2016 PHOTO#1 <br /> October 2016 D.O re ort with incorrect secondary containment test date <br /> Ifthly Visual I_ -is,.i ank(UST)Operator v <br /> Ins ection Checklist <br /> Date: 10/13/1 fi <br /> Cnn_d_uctin the Ins ction: Karen R71 Code:95340 <br /> it 'e icatton q:8032295.11 Amaiz <br /> ' Ez iration Date: OS/OS/I7 ` <br /> �� 't Phone:(209 518-0836 �` <br /> IMat' MON OGPANEL/ALA Y=YMN-Na NA=SWA nt< (D <br /> RM Fill <br /> Y N NA ' <br /> Monitoring s stem is veered on and in ro er o ratio mode. U) <br /> tMixtimrin s stem is not Mrs;mly,showin any alarms or w X <br /> aurin s. X <br /> 3 Alarm history U report/log for the previous month is available,and has been reviewed by the X <br /> Desi aced UST rotor. (Attach o co o the alorm histo re ort/lo to this orm i available.) <br /> 1 Each alarm for the revious month has been res nded to ro riatel . <br /> 5 Sensors Iaeated to tank-to containment sum shave not alarmed in theast month, X <br /> 58 List all tank-top sumps where alarms occurred in the part month <br /> ,Note Sumps where an alarm has occurred In e <br /> the past month must be inspectd unlessaqualhed service technician responded to.and <br /> el <br /> l '4 erh'add"wd the muse of the alarm.Aaach daume t elan verhl pd rn a service to this report. P <br /> / m. etton is Marred,record resubs in item 6.helou. <br /> UST SYSTEM INSPECTION <br /> 6 Tank-top containment sumps are free of water,debris,and hazardous substance. Sensors are located property. <br /> time I tsuol im coon a sum s is only required in sumps where an darm has occurred in the past month or which there is no service record <br /> Y N I Y N <br /> Sump Location:87 Fill X Sump Location: 91 Turbine X <br /> Sum Localion: 87 Turhine X <br /> Sum Location: 91 Fill X <br /> 7 S ill containment structures are free of water,debris,and hazardous substance. <br /> ►1 Y N NA Y N NA <br /> Tank I —Contents: 87 X <br /> Tank 2—Contents: 91 X <br /> 8 Under-dispenser containment areas are free of water,debris,and hazardous substance. Sensors are located Y tN rl NA <br /> Y N NA <br /> Dis enser I/2 X <br /> Dis enser 3/4 X <br /> Dis eraser 5/6 X <br /> Y N NA DATE DONE <br /> PAPERWORK INSPECTION IOR6115 <br /> 9 Monitorin Sy,stem certification has been com feted within ast 12 months. X 0'26116 <br /> hbeen com leted within there uired timeframe. X <br /> 10 Second containment tests ave IO 26115 <br /> 11 S ill containment structure(bucket testin was com feted within the ase ear. <br /> 12 Tank ti htness testin was com leted within re aired timeframe. <br /> 13 Line tmess testin was Completed within required timeframe. <br /> 14 Otheruired testin maintenance was com feted within re aired timeframe. (List test/maintenance items below <br /> i <br /> Test/Maintenance: <br /> T,wwaintenant <br /> Fatinah Zareef, REHS Page 1 of 1 <br />