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0 <br /> Q � jcslgnated UndergrouTto Otani a 8c <br /> M.:)11tl1ly Visual Inspect io . � C <br /> 0) Cn Facility Name: S Tint '-?-on Switch Dare' -_ � <br /> 3 m Fbcili Address: 380rCoronado Avenue _ __..._. — <br /> (D CCDD N City: Stockton 7_.i Gcrde. r.S?rt4 <br /> ;:;� Qesi natal lJ - <br /> e ator ConducEin the fns ection: Darren ftieck _ _ — _,__ ..___..__._._ r""- <br /> International e irarcn fate 05101!15 <br /> un�il Certification 53] 1076UC p _ <br /> ---- <br /> Signature: <br /> 0 V=Yes. It u,SA-Nof A 6r_ O <br /> Item MONITORING PANEL 1 ALARM HISTORY W! Y I <br /> 0 1 Monitoring system is owered on and in proper o eratina mode, _� <br /> 2 Monitoring system is not currently showin any alarms or warnings. <br /> CL <br /> -� 3 Alarm history report/lo;for the previous month is available, and has been reviewed by the <br /> v Designated UST Operator. (Attach a copy of the alarm history report/log tv:his form if available.) <br /> (D n 4 Each alarm for the previous month has been responded to appropriately. <br /> ! <br /> O 5 Sensors located in tank-top containment sumps have not alarmed in the past month. <br /> (p Sa List all tank-top sumps where alarms occurred in the past month e--F <br /> n <br /> O <br /> tl? Note.Sumps-where or,alarm has cc-tirred it the pas,month musl be respected arnlesc c qualified service technician resFonded t <br /> properly oddre.sed,rhe cause of rhe alarm.Allach documenration verifying approp,-rate_ervrce to 11715 report �nn <br /> Ifssm fns ect,o,?is required.record resulls in item 6,beloiv. V) <br /> co UST SYSTEM INSPECTION <br /> 6 Tank-top containment sumps are free of water,debris,and hazardous substance. Sensors are located p-operl O <br /> (D dote: Kssuol inspection h o sur 1.s is only required in st na s)there an ulama has occurred in the post month or which there r_na service r co-- <br /> Y N Y N <br /> Surip Location: Tgnk I Piping Sump Location: r <br /> p <br /> Sunip Location: Sump Locatijn: t <br /> cn <br /> SvtM Location: Sum Location: <br /> (D 0 7 S i4l containment structures are free of water,debris,and hazardous substance. -�04 <br /> © <br /> O Y N NA Y N <br /> - v�e <br /> co <br /> (D Tank I-Contents: Diesel Tard<3-Contears: <br /> y r► TF-d'2-Contents: X Tank 4-Contests: —�� <br /> v 8 Under-dispenser containment area,are free of water,debris,and hazardous sibstance. Sensors are located pro erly <br /> I- _ <br /> Y N NA Y N <br /> (D Dispenser 1/2 X Dispenser 9/10 _ O <br /> 0 Drs—Dispenser 3/4 X Dis eraser I1;?Z —� <br /> Dispenser S/6 XDis enser I r?a Q <br /> Q =3Q1 <br /> Dispenser ?/8 ,Y Dis enser• 15/!6 _ <br /> (D PAPERWORK INSPECTION Y N NA DATE DO <br /> 4 Monitoring system certification has been completed within past 12 montias _ �� CL <br /> a r 10 Secondary containment tests have been completed within the required timef-rarne, r 0 <br /> S1 I Spill containment structure(bucket)testino was completed within the past year. <br /> oCD 12 Tacit ti hitress testing"'as completed within required timefrarne. � Conti aou <br /> 13 Lint tightness testrno was completed within required timeframe, }( <br /> _Q 14 Omer required tt_stmLinaintenance was Completed within required timeframe. (List test./maintenance menus belo,. <br /> (D TestlAfaintevance <br /> 0 TosilBaintenance• X <br /> :J N TestlMainterance: X <br /> n <br /> p FACILITY EMPLOYEE TRAININGY n <br /> (D c15 All facility em loyees have received the re uired on-the-job training wit tin t-le past year. <br /> 3 n 16 Ali facility employees hired within thepast 30 days have received the requi-ed on-the-job training, Q <br /> (D - <br /> ute: Any answer of"N"should be explained in the comment section on-the following page, and will require <br /> v follow-tlp action_ <br /> 'V' <br /> A <br />