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• <br />Designated Underground Storage Tank (UST) Operator <br />Monthly Visual Inspection Checklist <br />Facility Namc: COSTCO 1031 <br />Date: 09/06/2016 <br />Facilily Address: 2440 Danicis St. <br />Y N NA <br />City: Manteca <br />Zip Code: 95336 <br />Designalcd LIST Operator Conducting the Inspeelian: Kaylynn Rammell <br />X <br />system is not currently showing any alarms or warnings. X <br />International Cod Council Cerli iicalion 0: 8456633 <br />Espimtiou Date: 6/15/2018 <br />Siglaaturc:(MI <br />Phone: (949) 460-5200 <br />Item <br />action. <br />' " • •'i 11 - nN NA - NOT Appllcahle <br />M1IONI'rOR1NC PANEL/ALARM HISTORY <br />Y N NA <br />1 <br />System is powered on and in pm cr operating mode <br />2 <br />X <br />system is not currently showing any alarms or warnings. X <br />3 <br />ry Ietwrtilog for the previous month is available, and has been reviewed by the Designated UST X <br />=alarm <br />Attach a copy orthc alarm hilaory reporvlog to this form if available.) <br />4 <br />for Tile previous month has been responded to apprnprietcly.5 <br />ted in tank -top containment sumps have not alarmed in the put month. <br />Sa <br />X <br />- List all tank -top sumps where alarms oaurtcd in the past month; <br />All lank -rap sumps. <br />NnA• .Benin --hers• nn nlnm+hws .rrrd in aha• post month mwt he impr ed unlerr, u.pmlyi'rdrrnire reehnieiun nom/»ndcd la• and prt,prr/r <br />uddreo.d. the cmae uf+hr'11"n" Attach doawmenlalian Irrifjini: oppropriatrse"in• ro thas r pon. lfsump imixrlion L rcquind• reconl nrula <br />in item 6, helow. <br />UST SYSTEM INSPECTION <br />6 <br />er, debris, and hararloas substance. Sensorsarclocatedproperly. <br />> A+ru•m nl+wW.Am+p"^YNWAY <br />Tankicontaiinmentnment sum@frmccof <br />N <br />Sump Location:Sump"'^ <br />Simtp Localion: wA <br />SumpwA Sump Location: wA <br />7 <br />Spill nt shuclums are, debris, and hazardous <br />substance. <br />Y N NA Y N NA <br />Tank-871t'i X Tonk-91 <br />Tank -87E X <br />X Tank -additive X <br />8 <br />Under -dispenser conlainnncnt --runs arc rrec of water, debris, and hazardous substance. Sensors arc located properly. <br />V <br />N NA Y N NA <br />Dispenser -I/? X <br />Dispenser -9110 X <br />Dispenser -314 X <br />Dispenser -11112 X <br />Dispenser -516 XDispenser-!3//4 <br />X <br />Disperucr-71X X <br />Dispenser -/5/16 X <br />PAPERWORK INSPECTION Y N NA DATE <br />9 Monitoring system certification has been complctcd within past 12 months. X WIW16 <br />10 <br />Secondary containment tests have been completed within the required timeframe. X WA <br />1 I <br />Spill containment structure (buck:) testing was completed within the past year. X 8/18/16 <br />'tank tightness testing was completed within required timernunc. X NIA <br />Line tightness testing was complctcd within required timeframe. X NIA <br />r1314 <br />Other required icsting(maintenance was completed within required timeframe. (List lesUmain(enance items below) <br />TcS111th Aarmutce: X <br />Tesilblaiurenanc•e: - X <br />Trsr/Maintenance: X <br />FACILITY EMPLOYEE TRAINING y <br />N <br />NA <br />I? All facility em loyees hoe rcccivcd the required on -Lane job tmining wi0dn the past year. <br /># <br />16 All facilily employees hired within the past 30 days have received the required on-the-job training. <br />Nor,- <br />nlc <br />X <br />uctiml. <br />--- --- -- - ---- - •-- --r•-•••••• ••• •••� �......••vr••, xcuon on me muowrag pagq and will require follow-up <br />Page I of 2 <br />)�r <br />