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<br /> O UNDERGROUND STORAGE TANK SYSTEM 0 0
<br /> DESIGNATED UST OPERATOR MONTHLY INSPECTION a
<br /> � _j
<br /> (V REPORT J
<br /> Facilitv Name e
<br /> 1 ^ Oa5i5 Pleza Utspccuo"Uri'- N
<br /> �ITJ I'"cilily Addna -- - April 25,2014 o
<br /> 800 S. Cherokee Lane Ciiy: -- - ---- N
<br /> -- _ ____ Lodi, CA 95240 - _ -
<br /> Namcorr""Vu'atal US I'i)Ix;rmor t'undu,amg Alex Jabban -- - O
<br /> Imcmnhonel Ctdc Cnuncd CoroL,uho°Nn 5243897-UC .�
<br /> U — — — — — —_ fixp noun Dam
<br /> Signamm� i 101212012 O N
<br /> ' Q-' -�� ]'hon": (9251 389-1262 - -
<br /> r C
<br /> Ilem MONITORING PANEL/ALARM HISTORY' ��'�'N'".t I�,me N N
<br /> I j Is the munimnnE s stc�+orccred nn and In proper v,,"' tin+mode! iYesj IN,, NIA T Q
<br /> Q _ hili"munitonnzrtnn not.nn�ntl� shuniamlcal.;lla>m,' -'--- 3 O
<br /> J --rf Iht 11arm 111 IIn Ryon li tl , Ihc.inti it m mih rutilahlc.and lira it txrn ret ua (6
<br /> � Ikvenalcd lltil ()petrt r' r ( 1 h , .,/t iu, Ler+n hislorvreorflne to thisin� vd l�Ihc i Q Oa
<br /> J jlfa,v¢h nluanl rthcllcn,urian hba nn ndeJ t ,a++ -. r --- eti rn rnnr
<br /> __ _--_� ❑r❑ �_ O
<br /> J - - (i�T�Tshp;It )"ISPECTION' - - M
<br /> _. Am tank-tap vonl'nntncla rump tmc ul iw,ner, i I
<br /> its, m - _ 1 N
<br /> ".1:{ slip to fluor G Sum s a lmra d I19Lafdnuy:SULlatanee? 1INe./ t o un :—
<br /> ^, P ua alarm laar oacanw!Ia rhe n l ,werto Item I,ear Yu. u E
<br /> W rrA amt ro rh addmtred the coast Wthe olmm.l�xomrmm�oa] momh ma,t ha mrpected�o 4mll�ed,rrvlce terhNe/ea hm rtw rc.�mlru
<br /> Al No Sum alarm ro note:e vi"„houw hs wmchwmrM, I N
<br /> VJ Y°s N" No Sum alarm
<br /> Sum Location: Yes Q� d
<br /> _ Sum Location: O
<br /> �
<br /> O Sum Locmion: J Sum Location:
<br /> ti. Ams in inchs Nomamment structures freeofivat0r,debris,and hazanious substance? rn
<br /> L - � .
<br /> r�II� Yrs No N/A m
<br /> W Tank I ID-12c alar Yes Yu NIA O
<br /> L Tank_211)-Diesel 'fmtk 3lD-Premium
<br /> Tank 41D- O to
<br /> Ui Areunder-di. ense:rcontutement areas free orwata,debris,and hazardous substaneel M M
<br /> Yrs No N/A Yes No N/A
<br /> U �
<br /> Di, mu;1112 Di. nscr-9/10
<br /> �/N Des cn.cr-3/q ��('�
<br /> V J Dh • ser 11112 O
<br /> Ui, u.er-jJ6 Dra nate l t I 1 �--fFtLu�1 (�{-LLr•rJJ-
<br /> O UisLvwr-7/S r-7'�^ ry� - 3
<br /> LJ�i.J�... Dt. mser l o i N
<br /> O S.� Leak detection is ro eriv located within under-dispenser containment
<br /> co
<br /> r�
<br /> W D na-r-IC' Yat No N/A _ _ _ Yrs Nn .\/.1 N M
<br /> Di nseT-3/4 DI -nwr ' II _ - I ' -�
<br /> Dlr entir �'
<br /> f Dt War—�16 —
<br /> — O _
<br /> ° m
<br /> L
<br /> PAPERWORK INSPECP[ON _Yin No IN/A Date Done O
<br /> 9. Monitoring System Certification was Completed wulun the past 1 mond,-, � � _3/25/2014 - �
<br /> 10. Secondary mmainmerol tu-ets complcled asvhm ilia r'.ywn 1 t,r a finmc" -- ❑ �_ _3/22!2012 ~
<br /> I I. Spill bucket(wnlninmcnl sWclmel tc,t111 rnply ted.n llwt tht pmt I'nunuhs! ❑ _3/25/2014 �
<br /> I2 Tank,1361thi y testing completed ribc T (ha u�quncd trnx Irunc'- _. . - j 1 O O
<br /> 13. 1-me tightnev testin aan
<br /> J 15. 011= g P Ilhm the myuud unm liwnc' ❑ ❑ __ N
<br /> aired Icstin muinlennnCe was eosin I,jed_+,,thm re1tumJ ittic Banc" ll.r.v ,.w inainrrrmnce•rh'ms helms.! O
<br /> I)csccsvMaimrnance-TP-2!i l_1 and l 1, 2,,i I — - — 3252014 Q C
<br /> Ili rI Tcst/Mam4mancc __ O O
<br /> N � "
<br /> PACQ.ITY EMPLOYEE TRAINING Yet No N/A a)
<br /> 16. jIi.'m.IIrXihIy= lovers rece•Ivut the r• uimd on-dic-oh tmtmn svtthur the past%car" M O-
<br /> 17 Hese all facility em 1 '� hired within the ten 30 dans rowNcd the rec fired on-the-ob trainin .? 0).0 00
<br /> \de: E.Xplm any"No`anszveas in the-Com men&*action on the rollm,ing page.Those issuew mquim corrective action Iron to T O
<br /> the UST ownrrlop,,tm N
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