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Designated Underground Storage Tank (UST) Operator <br /> Monthly Visual Inspection Checklist <br /> lI^aGilit Name-. � � Date: <br /> Facilit Address: _ <br /> 01Y. Zip Code: IZI 1 <br /> Valley Underground Tank Monitoring <br /> Mailing and Remittance Address: Valley Underground Tank iVionitoring <br /> P.O. Box 91 <br /> Stockton, CA 95201 <br /> Dt�- neted UST operator Conductinq the Ins ection Dan McILrath <br /> —UC - Ex iration Date: 02/07/2011 <br /> 5i�nature: I Phone: 209-649-8956 <br /> Y=Yes, N=No, NA=Not Applicabie <br /> ltern _ <br /> Monitoring Panell Alarm Histo Y N NA <br /> FRispowers on an m proper operatin mo e <br /> urilloring system ,s not current y s owing any alarms or warnings. <br /> Alai in rstory repo og ort a previous monf s avat a e,an as een reviews <br /> by the Designated UST Operator. (Attach a copy of the alarm history report/jog if available). <br /> rl ac>'a arm orf e previous monf as sen vesper a fn appropnate y. <br /> 5 ensors oca a in tank-top <br /> containmen sumps have no alarmed in a pas mon <br /> a ist a t; n -top sumps w ere a arms occurred in the past monf : <br /> 1voitt: Sumps where an aLirrr,has occurred in the past month must be inspected unless a qualified service <br /> techrgckirI responded to, and properly addressed,the cause of the alarm. Attach dacurrientation verifying <br /> approphulL service to this reportif sump inspection is required,record results in item 6, below. <br /> UST S stem Inspection <br /> n _top containment sumps are vee o water, a ns,an hazardous su stance_ <br /> Sensors are located property. Note:Visual inspection of sumps are only required <br /> j,1 s,.. �s where an alarm has occurred in the past month for which there is no service record <br /> ump ocatton: ump ocatton: <br /> um ocatton= Sump ocatton: <br /> ump ocat,on: ump ocatton: <br /> pi containment structures are ree o water, ens,an azar ous su stance_ <br /> an - onte,�ts: an - ontents. <br /> Tangy- ontents: an 4 Contents: <br /> n er- tspenser contain 4 ent areas are ree o water,debris,and hazardous substance. Sensors <br /> ale located propeirly- <br /> Dispenser ,spencer <br /> tspenser, 3 tspenser <br /> —ib peilser 57 tspenser 4 <br /> is enser tspenser <br /> Paperwork Inspection Y N NA <br /> ondonng system cerci Icatian as sen camp ere wit in past monf s. <br /> Secon a containment tests ave sen compete within require time rame. <br /> P', contatnrneni structure uc et testing was compete within past years <br /> an Lig tress testln was comp ere wit in require time names. <br /> ine fig tness testing was completed within required time rame. <br /> er require es ing main enance was comp s e wt in require tme rame. (fist maim. items be)ow}. <br /> Te—s- maintenance_ <br /> Test7m—a nance: <br /> es n,atntenaizce: <br /> Facilit Em to ee Trainin Y N NA <br /> Trac;,ty erne oyees ave receive te require on-1 a-to Ira in!ng ir1e t past year. <br /> a�ctltly emp oyees ire wit int e past ays ave f eceived the require <br /> on-ttie-ob irainincg. <br /> Now. Any an of "N" should be explained in the comment section on the following,page, <br /> and will require follow--up action. <br /> Pg. i of 2 <br />