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Shirgyr Environmental CorplOation <br /> Designated Underground Storage Tank (UST) Operator <br /> Monthly Visual Inspection Checklist <br /> 0 Facility Name: Stockton, CA Switch Date: 3-15-2007 <br /> Facility Address: 3807 Coronado Ave <br /> City: Stockton kip Code: 95204 <br /> Designated UST Operator Conducting the Inspection: Richard Thomas <br /> International Code Council Certification#: 5254236-UC lExpiration Date: 2-13-2008 <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 /> 3 Alarm history report/log for the previous month is available, and has been reviewed by the X <br /> Designated UST Operator. (Attach a copy of the alarm history report/Jog to this form if available) <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 /> Nole: Sumps where an alarm has occurred in the pas,month must be respected unless a qualitted service lechnrcfan 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 alarm has occurred in the past mmnth for which there is no service record. <br /> Y N Y N <br /> Sump Location: UST Piping X Sump Location: N/A <br /> Sump Location: AST Piping X Sump Location: NIA <br /> I Sump Location: Sump Location: NIA <br /> JJ 7 Spill containment structures are free of water,debris,and hazardous substance. <br /> Y N NA Y I N INA. <br /> Tank 1 -Contents: UST Fill X rank 3-Contents: X <br /> Tank 2-Contents: AST Fill X rank 4-Contents: X <br /> 8 Under-dispenser containment areas are tree of water,debris and hazardous substance, Sensors are located properly. <br /> Y N NAI Y I N NA <br /> Dispenser 1/2 X Dispenser9/10: X <br /> Dispenser 314: X Dispenser 11112: X <br /> Dispenser 516: X Dispenser 13114: X <br /> I <br /> Dispenser 718: X Dispenser 15116: X <br /> PAPERWORK INSPECTION Y N NA HATE DONE <br /> 9 Monitoring system certification has been completed within past 12 months. X 9-12-2006 <br /> 10 Secondary containment tests have been completed within the required timeframe. X 10-28-2005 <br /> 11 Spill Containment structure(bucket)testing was completed within the past year. X 9-12-2006 <br /> 12 Tank tightness testing was completed within required timeframe. K Continuous <br /> 13 tine tightness testing was completed within required timeframe. <br /> 14 Other required testingimaintenance was completed within required timeframe. (List test/maintenance items below.) <br /> Test/Maintenance: X <br /> Test/Maintenance: X <br /> Test/Maintenance: X <br /> FACILITY EMPLOYEE TRAINING Y N NA <br /> 1511 facility employees have received the required on-the-job training within the past year. X <br /> 16VII facility employees hired within the past 30 days have received the required on-the-job training. X <br /> 0 i Nate:Any answer o should be explained in the comment section on the following page,and wi i requirefollow-up action. <br /> Shirley Environmental Corporation <br /> 9595 Lucas Ranch Road, Suite#100, Rancho Cucamonga, CA 91730 <br /> 800-533-4030 <br />