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Shin ,I Environmental Corp ration <br /> 9 g <br /> round Storage T <br /> Designatender Tank � Operator <br /> � � <br /> Monthly Visual Inspection Checklist <br /> -,acility Name: Stockton, CA Switch Date: 11-15-2006 <br /> acility Address: 3807 Coronado Ave <br /> City: Stockton ip Code: 95204 <br /> Designated UST Operator Conducting the Inspection: Paul Magana <br /> International Code Council Certification#: 5248714-UC Expiration Date: 6-25-2007 <br /> Signature: Phone: 909-476-7443 <br /> Y=Yes, N=No, NA=Not Applicable <br /> Item MONITORING PANEL/ALARM HISTORY Y N NA <br /> 1 Monitoring system is powered on and in proper operating mode. X <br /> 2 Monitoring system is not currently showing any alarms or warnings. X <br /> 3Alarm history reporUlog for the previous month is available, and has been reviewed by the <br /> Designated UST Operator. (Attach a copy of the alarm history report/log 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 qualitted service technician responded to, and <br /> property addressed, the cause of the alarm. Attach documentation verifying appropriate service to this report. if sump inspection is required, <br /> record results in item 6, below. <br /> MONITORING PANEL/ALARM HISTORY <br /> 6Tank-top containment sumps are free of water, debris, and hazardous substance. Sensors are located properly. <br /> Note: Visual inspection of sumps is only required in sumps where an alama has occurred in the past:month for which there is no service record. <br /> Y I N Y N <br /> Sump Location: L1 X Sump Location: <br /> Sump Location: Sump Location: <br /> Sump Location: Sump Location: <br /> 7 Spill containment structures are free of water, debris, and hazardous substance. <br /> Y N INAI Y N NA <br /> Tank 1 -Contents: Diesel bucket X ank 3-Contents: <br /> Tank 2-Contents: rank 4-Contents: <br /> 8 Under-dispenser containment areas are free of water, debris and hazardous substance. Sensors are located properly. <br /> Y N NAI Y N NA <br /> Dispenser 1/2 X Dispenser 9110: X <br /> Dispenser 314: X IDispenser 11112: X <br /> Dispenser 516: X IDispenser 13/14: X <br /> Dispenser 7/8: X IDispenser 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. 10-28-05 <br /> 11 Spill Containment structure (bucket)testing was completed within the past year. X 11-15-06 <br /> 12 Tank tightness testing was completed within required timeframe. <br /> 13 Line tightness testing was completed within required timeframe. X 11-5-06 <br /> 14 Other required testing/maintenance was completed within required timeframe. (List tesUmaintenance items below.) <br /> Test/Maintenance: X <br /> Test/Maintenance: X <br /> Test/Maintenance: X <br /> FACILITY EMPLOYEE TRAINING Y N NA <br /> 15 All facility employees have received the required on-the-job training within the past year. X <br /> 16 p facility employees hired within the past 30 days have received the required on-the-job training, X <br /> ote:Any answer o should be explained in the comment section on the following page,and will requirefollow-up action. <br /> Shirley Environmental Corporation <br /> 9595 Lucas Ranch Road, Suite#100, Rancho Cucamonga, CA 91730 <br /> 800-533-4030 <br />