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0 • <br />Designated. Underground Storage Talk ([QST) Operator <br />Monthly Visual a9DCCt an Checkhgt. <br />T em <br />1Vior Ori is powered on .aud in <br />Ficilit Address: 5t, Z_ <br />CF <br />Ilp Cade_. { <br />besi ted UST Operator Comdac-tin the John Daley <br />Alazm history repcnllivg for the previorts month is available, and leas been reviewed by the <br />International Codd founcil Cerdfication # SOON863 - UC <br />iatiam Date: Naven&wr 24 2011 - <br />S e_ <br />Phcau : ( 916 ) 217-1373 <br />MdkikiG PANEL / ALARM H)fS )P RV I Y I N I PEA <br />1 <br />1Vior Ori is powered on .aud in <br />2 <br />Monitoriizsystem is not ShSawim axil+ alarms or VVIrm not <br />3 <br />Alazm history repcnllivg for the previorts month is available, and leas been reviewed by the <br />Drw tcd UST car. 0 ttnrh a as the akmn history reparidogto #his orm i avadlahle_j <br />4 <br />Each alarm for the month h— been nded to a <br />5 <br />Sensors located ire tank -top conUmmentsurops have not alarm in the past tF►oFFth- <br />5a <br />List 1 tank -top sumps where alarms oavr ed in the past math. <br />Nate- Sw r wPrase an alarm has rrrd in dws p,asr Md.Ah ,,vast b® inspected brrd-,% o g wahped rarnce I -)N Rtarl r"poaridad to, mid <br />Frill ad&ess*4 the cam3e q ihs aLw 1>h'ul.'/z dommmumm vetifift oppnTrjaw WVJ'V to M?.y nepart <br />kfm m ehy Gtiorr iS rtwgraired rward results in item f below <br />-. Il' ,I,'.r'.' 3},.• ..s 4,4 W.i . `.jl ...'tJ:;l:i>. `:,' <br />UST SYSTEM 0SPECTION <br />6 <br />Taitic-top contai)Fx mt sumps are free of water, delxir�, and hazardous aubstai►cc. Sensors are located properly, <br />lvate7 "mal iris trout oflumps is.&Fdy M s where an alarm has ac cured in thepan n awh or which there is »o senqce record <br />Y N ry N <br />Sum rt)cration_ 91 r*"� SumpLocatian: <br />Sum L <br />Sump t39iarmpariaPr: Diesel ? <br />Sump Location_ State peation: <br />7 <br />containment �s are frce of watEr, debris, and hazardcatts substance, <br />N NA Y N . NA. <br />TankContents: 91 r a - Tauk 3 -Contents: $� r fez <br />LT;ank <br />Contents: 39 Tank 4 - Cantentts: Diesel <br />s <br />U> -&cowaflommt areas are feel of water, debris mid taazardaus substance- Sensors are located pr rl y. <br />- Y N NA Y N 1tiA <br />Dis user 112 Dispenser 9110 <br />Dis user -1,/ <br />r)i rases 11 / 12 _ <br />Di eraser S / 6 <br />Disirensfr 13 f 14 <br />Dispenser 7 % & <br />Dispenser 15 / 16 <br />PAPERWORK INSPECTTON <br />9 Moniiaring system certifieation has been completed within past 12 month& _ <br />10 Seco conlair nxmt tests Have beech completed within the requi�reC1 tittle&ami. <br />11 Sill containment sUcrine ket) was Lftxl within the past year° <br />12 Tank ti to tam was cora rled within roqtured timet _ <br />13 Line tk9btness was completed within r+ d timef one. <br />14 Other re aired tmhn mauacname was completed witinn wred timeframe, (L <br />Test,Maintenwice_ Leak Detechon rvi <br />2'esfl_1L�arntenance_ <br />NA DATE DONIK <br />item h�Eloi�Et,)4t <br />FAt QTY EAWLOYEE TI AMMG Y <br />L15 All facilF�ty eloyees have received L4e aired can-tite-jcifa trauui witliut the ear. <br />X111 facih empl es hired wilMn the 30 das have received the o>E►A b trd iiin - <br />r Note. Any answer of "N" shonld be eViaiited in tate comment wAom on #lie folloarruag 11 Hiu[i will require <br />follow-up actiod. <br />Page 1 of 2 November 2004 <br />5T/89 39Vcd PILTISB 8VT868S-6K VE:L0 TT0Z/EZ/Z9 <br />