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Designated Underground Storage Tank S') 4peor <br />MontMv Visual Inspection Checkhst . <br />Fa Nam: �"' KGs <br />r� / Date - Z6 - <br />acilitvAddress: <br />"r <br />City: <br />I Zip Code: <br />Desi UST <br />Conducdn the n: John Dale <br />lntertutfioxw C <br />1 Cutificatim 0 8000"3 - UC tion Date: November 24, 2011 <br />Si <br />Phone: ( 916 217-1373 <br />I = r rr = tvo, tvsi, =;.rot p Lamle <br />Itctn 1TORING PANEL/ A(.ARM MSTORY Y N NA <br />.n. _.n.•y • - .. .. � .> •�� "�...... .u�. :�.... -. i ui-� .xf. s' �� _ f- �^_. V.' `.. M.f ... �j. ��.,: °`:.::.: .c s - J.a J. N�'�<.`LV:YX•. ��i.: 3Y :Yi++_ <br />1 <br />Mr3rlltOLlh mmtem 1S owt and to proper opantingmode. <br />2 <br />Monitoring= is not CFS TentlY !bGwm 2M alaims or warA'mgs. <br />3 <br />Ala mr history reportllog for the previous month is available, and has been reviewed by the <br />Bd UST or- (4ttarcash a o the atom history re to chis orm i available. <br />est e <br />4 <br />Each alarm %r the ow mentlt hats bow to <br />5 <br />Sensors located in tank -top contaimnent mugm have not alarmed in the past month <br />5a <br />_ List all tank -top sumps where alarms occurred in the past month: / f Q &-f, <br />` w = e'- - <br />Vote: Amps where an alarm frac occurredin the pant mnwh asaar be brspecmd unleso a tlarnitjted se1VFa8 reohnsctan responded ro, and <br />properly addressed ihe,r== of the afar ne Adach domonmiaticm vwr6 ft oppropriaie service to this repos r• <br />J are iii eNian is ired, record rgMd t in'iaem d befaw. <br />UST SYSTEM INSPECTrON <br />6 <br />Tank -top corlri+;nment sumps the fret of water, debris, and hazardous Baibmnnrt Sensors are located praperly. <br />Note: 3Rsual inn ction sum J& on rad i�eTrY�a7whers an alarm hda occurred in the at monthfor which thane fS +no Tervice record. <br />io <br />Secondary camaimnew toe have beon completrA wid n the required d mefratme. <br />A SNIP -�. y <br />1\ <br />f M- YIP <br />12 <br />Sum Location: <br />SumR Locakan: <br />Sum Location: <br />91 �r,' <br />89 Sum LoGYJficm: Dieml <br />�`, ,yam Location: <br />ti ,.•, .,, <br />7 <br />,,,,,,.t <br />deb <br />Spill containme t aructures are Prix bf vr2.tcx, debris, � hazardous 9AOance, <br />7'estlMaintenance.- Leak Detection <br />Y N NA I V <br />N <br />PYA <br />r,;;.,.•r. <br />Tank I - Contents, <br />91LNa,1 Tank 3 - Contents: 8 7,4 r'9- a <br />Tank 2 - Contents: <br />89 Tank 4 - Contenis: Diesel <br />S <br />Urdu dtsp r r cxtyaimment <br />xr-ms are free of rwate - detbi s, and lw7 wdoas srtbs-tartrt. Sensors are located proerly. <br />Y N NA <br />TV N <br />NA <br />Dispenser 1/ 2 <br />Di neer 9/10 <br />2 ser 3 14 <br />Di nser 11 / 12 <br />Dispewer5 16 <br />� - <br />Di. ser 1.3 114 <br />Dispeawr 7 /8 <br />Dispenser 15 / 16 <br />PAPERWORK INSPECTION - - T Y� fN 1 NA DA'L`E llONLr <br />9 <br />Monrito ' system kation bas b=n completed with past 12 uwnths. lei I I` <br />io <br />Secondary camaimnew toe have beon completrA wid n the required d mefratme. <br />11 <br />Spill contalnmemt structure (bucket) tCSbBg was ODMPIdCd wriltr}f the ear_ <br />12 <br />lAn1E tZghtmess twin was MM pleted.'%ithin timefmm_ <br />13 <br />Line ti bbiess testukg was coraplc 4 within requ aed timef mue. <br />14 1 <br />Otho pRTAW tcsd duce rv�s ietcd w�ithio tin trC. (List test✓mat ennnce items below. <br />7'estlMaintenance.- Leak Detection <br />3'esMafntenance: <br />r,;;.,.•r. <br />2"est�fatntena�xce: <br />.. ka:f Yn ra:AN !' ii.J�d,.i !:Ya.„�4 'i d',%i4'S.'a, .. °r q�•<EN'h'.R -'X'a�i' x'n F,:?.ir!f.' •.-s?r'�'7Ja. .: J°7�u: , >:..t:. ...a a;._v, ...a..i. <br />r: ari .'r:.C.. y nSwv .,_'. a. Pr; rrt,E:...J <br />15 All ficility employ( <br />16 1 All facility employ( <br />Note: Any answer of "N” <br />follow-up action. <br />IFACR f rY XbWLOYM TXArN1MG <br />have rived the required on -tire job trammg within the past year. <br />hired wit!» ft past 30 days have r=ivM the c ured on job <br />laid he erpWaed in the comment sertiomon the following page, <br />Page 1 of 2 <br />rcqulire <br />November 2004 <br />LZ/L3 3ovd bTLTISO 8VT6669-69U 81?:L0 TTOZ/8Z/Z0 <br />