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0 <br />0 <br />Designated Underground Storage Tank (UST) Operator <br />Monthly Visual Inspection Checklist <br />FocililyNannc: C0S3'C01031 <br />• <br />Dale: 08/05/2016 <br />Facility Address: 2440 Daniels St. <br />Monitoring System is powered on and in proper operating mode <br />Monitoring system is not currently showing any alarms or warnings. <br />Alamm history reporUlog for the previous month is available, and has been reviewed by the Designated UST <br />Operator. (Attach a copy of the almm history reporVlog to this forth if available.) <br />City: Manteca <br />Zip Code: 95336 <br />Designated UST Operator Conducting the Inspection: Kaylyan t2ammell <br />X <br />X <br />International Code Council Ccr iff tion 0: 8456633 <br />L•xpimtion Daic• 6!!5/2018 <br />Signature: <br />Phone: (949) 460-5200 <br />Item <br />..1- —-,.,nppacnate <br />MONITORING PANEL/ ALARM11IS70RY Y I N NA <br />1 <br />-2 <br />3 <br />Monitoring System is powered on and in proper operating mode <br />Monitoring system is not currently showing any alarms or warnings. <br />Alamm history reporUlog for the previous month is available, and has been reviewed by the Designated UST <br />Operator. (Attach a copy of the almm history reporVlog to this forth if available.) <br />X <br />X <br />X <br />4 <br />5 <br />Each alarm for the previous month has been responded to appropriately. <br />Sensors located in tank -top containment sumps have not alarmed in the past month. <br />X <br />X <br />Sa <br />- List all lank -lop sumps where alarms occurred in the past month: <br />Nulr: Stool- srhmr an alarm hal hemmed In thelmu month mart he itupected unless a quailli,d service technician nvpnnded m, and pmp,,rly <br />mhroll 6.. the came a%the alarm. dnarh do,vmrntmion Irrih"W nppropri arsenim lu tills rcpan. !/crump impeetion it mquind record resins, <br />in item 6, i" 101.. <br />UST SYSTEM INSPECTION <br />6 <br />Tank -top containment sumps are free of water, debris, and hazardous substance. Sensors arc located properly. <br />> Nua:l'uwflnmsron ef+wWa,Wt rcedrN/nrwynAArrc an conn Aw ortyrrrdlnfhrtnawnlaA/w „AhAtbrrr4noarnM•rivrd <br />Y N <br />Y N <br />Sump Location: W' A <br />Sump Location: wA <br />.Stmtp l oculian: WA <br />Somp Location: "'A <br />Suntp Location: wA <br />Sump Location: <br />7 <br />Spill containment structures arc rice of water, debris, and hamrdous substance. <br />Y N NA <br />Y N NA <br />Tank-871VI X I I Took -91 <br />X <br />Tank -87E I XL I I Tank-addilisc <br />X <br />8 <br />Under -dispenser containment areas arc free of water, debris, and hazardous substance. Sensors are located properly. <br />Y N NA I <br />Y I N INA <br />Dispenser112 X Dispenser -9/10 <br />X <br />Dispenser -3111 X Dispenser -///12 <br />X <br />Diaperaer-5/6 X Dispenser -13/14 <br />X <br />Di4penser-7/8 X Duprnscr-!5/!6 <br />X <br />PAPERWORK INSPECMON Y N NA DATE <br />9 <br />Monitoring system certification has been completed within past 12 months. X <br />8/19115 <br />10 <br />Secondary containment tests have been completed within the required timeframe. X <br />NTA <br />I 1 <br />Spill containment structure (bucket) testing was completed within the past year. X <br />8119/15 <br />12 <br />'tank tightness testing was completed within required limeframe. x <br />NIA <br />13 <br />Linc tighhtess testing was completed within required tinlcfnunc• X <br />N/A <br />14 <br />Other required tcsting/mainicnance was completed within required timeframe. (List tcst/mainienance items below) <br />Tis0faitncnance. X I NIA <br />Tcrl/AlainlcnancC: X I <br />NIA <br />__ <br />TesUMait renance: X <br />NIA <br />FACILITY EMPLOYEE TRAINING <br />Y N NA <br />IS <br />All facility em loyces have received the • uired on-the-job training within the past year. <br />X <br />16 1 <br />IN....., <br />All facility employees hired within the past 30 days have received the required on-the-job training. <br />w.... .... ..coon _�_....._ <br />X <br />.c-.-• ^••� ..• <br />Hellon. ,. n„aa.N .,c cApl.ulea to otc comment section on the following page, and will require follow-up <br />Page I of 2 <br />