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Shir Environmental Corp tion <br /> Designated) nderground Storage Tank (U� p erator <br /> Monthly Visual Inspection Checklist <br /> fVacilfty <br /> ame: Stockton, CA Switch Date: 10-25-2006 <br /> ddress: 3807 Coronado Ave <br /> StocktonCode: 95204 <br /> ged UST Operator Conducting the Inspection: Fabian Gomez <br /> International Code Council Certification#: 5246134-UC xpiration Date: 12-27_2006 <br /> Signature: <br /> Phone: 9p9_476-7443 <br /> Y=Yes, N=No, NA=Not Applicable <br /> I <br /> tem MONITORING PANEL t ALARM HISTORY Y N NA <br /> onitoring system is powered on and in proper operating mode. X <br /> s stem is not current showln an alarms or wamin s. X <br /> 3 arm history reportllog for the previous month is available,and has been reviewed by the <br /> Designated UST Operator_ (Attach a copy of the alarm history report.4og to this form if available) X <br /> 4 Each alarm for the previous month has been responded to appropriately- X <br /> 5 Sensors located in tank-top containment sumps have not alarmed in the past month. X <br /> 5a - List all tank-top sumps where alarms occurred in the past month: <br /> None. <br /> Note: Sumps where an alarm has occurred in the past month must be Inspected unless a qualified servlaes technivan responded to,and <br /> property addressed,the cause of the alarm, Attach documentation verifying appropriate service to this report. If sump insi)&cdon is required, <br /> record results in item 6,below. <br /> MONITORING PANEL 1 ALARM HISTORY <br /> 6Tank-top containment sumps are free of water,debris,and hazardous substance. Sensors are located property. <br /> Note: Usual inspection of sumps is only required in sumps where an alarm has occurred fn the past month for which there is no service record. <br /> Y N Y N <br /> Sump Location: L-1 X Sump Location: L-4 X <br /> Sump Location: L-2 X Sump Location: <br /> Sump Location: L-3 <br /> _IJ Sump Location: <br /> 7 Spill containment structures are#rep of water, debris, and hazardous substance. <br /> Y N NA Y N NA <br /> Tank 1 -Contents: X ank 3-Contents: <br /> Tank 2-Contents: X rank 4-Contents: <br /> 8 Under-dispenser containment areas are free of water, debris and hazardous substance. Sensors are located properly, <br /> Y N NA –Y—TN--. NA <br /> Dispenser 112 X ispenser 9110: X <br /> Dispenser 314. X ispenser 14112: X <br /> Dispenser 516: X ispenser 13114: X <br /> Dispenser 718: X ispenser 15116: X <br /> PAPERWORK INSPECTION Y N NA DATE DONE <br /> 9 Monitoring system certification has been completed within past 12 months. X 9-,12-06 <br /> 10 Secondary containment tests have been completed within the required timeframe, X 10-28-05 <br /> 11 Spill Containment structure(bucket)testing was completed within the past year. X 10-28-05 <br /> 12 Tank tightness testing was completed within required timeframe. X Continuous <br /> 13 Line tightness testing was completed within required timeframe. X Unknown <br /> 14 ther required testing/maintenance was completed within required timeframe. (List testlmaintenance items below.) <br /> TestlMaintenance: <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> FACILITY EMPLOYEE TRAINING Y N NA <br /> 15 1 facility employees have received the required on-theyob training within the past year. X <br /> 16 11 facility employees hired within the past 30 days have received the required on-the-job training. }( <br /> o e: fly answer of'N"should De explained in the comment section on the toltowing page,and YAII require o ow-up a eon. <br /> Shirley Environmental Corporation <br /> 9595 Lucas Ranch Road, Suite#100, Rancho Cucamonga, CA 91730 <br /> 800-533-4030 <br /> 800-533-4030 <br />