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Desig nand Underground Storage Tank (USAperator <br />Monthly Visual Inspection Checklist <br />01/27/2009 <br />RYDER 1071A Date. <br />Facility Name. <br />Facility Address: 3633 DUCK CREEK, DRIVE <br />City: STOCKTON <br />Designated UST Operator Conducting the inspection: CFERRUCCI <br />International Code Council Certification #: 5323096 -UC <br />Signature: <br />Zip Code: 95215 <br />Expiration Date: 11 / 2 0/ 2 0 0 9 <br />Phone: (209) 943-3213 <br />Y = Yes, N = No, NA = Not Applicable <br />He MONITORING PANEL 1 ALARi41 111STORY Y N 1 NA <br />I Monitoring system is powered on and in proper operating node. 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/logreporillog to this forin i available.) _ <br />4 Each alarm for the previous month has been responded to a ro riatel . X <br />5 Sensors located in tank -(op 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 />ALL ALARMS DUE TO TESTING BY BALCH PETROLEUM 1-16-09 <br />Note: Sumps where an alarm has occurred in the last month must be inspected unless a qualified service technician responded to, and <br />properly addressed, the cause of the alarm. Attach documentation verifving appropriate service to this report. <br />Ifsump inspection is required, record results in item 6, helow. <br />6 Tank -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 month for which there is no service record <br />Y N N <br />Sump Location: SUmp Location: <br />Sump Location: Sump Location: <br />Scam Location: Sum Location: <br />7 Spill containment structures are free of water, debris, and hazardous substance. <br />Y N NA Y N NA <br />Tank l - Contents: DEL X Tank 3 -Contents: NEW OIL X <br />Tank 2 - Contents: DSL X Tank 4 -Contents: USED OIL X <br />8 Under -dispenser containment areas are free of water, debris, and hazardous substance. Sensors are located properly. <br />Y N I NA Y N NA <br />Dispenser 112 X Dispenser 9 / 10 X <br />Dispenser 3 / 4 X Dispenser 11 / 12 X <br />Dispenser 5 / 6 X Dispenser 13114 X <br />Dis enser 7 / R X Dispenser 15 / 16 X <br />PAPERWORK INSPECTION Y N NA DATE DONE <br />9 Monitoring system certification has been completed within past 12 months. x 01/16/2009 <br />10 Secondary containment tests have been completed within the required timeframe. X 01/16/2009 <br />H Spill containment structure bucket tes ng was completed within the past year.X <br />01/16/2009 <br />12 _ Tank tightness testingwas completed within the required timeframe. X <br />13 Line ti htness testingwas completed within the required timeframe. X <br />14 Other required testing/maintenance was completed within required timeframe.(List test/maintenance items below.) <br />Test/Maintenance: X l l <br />Test/Maintenance: X <br />Test/Maintenance: X l l <br />MONITORING PANEL 1 ALARM HISTORY Y N I NA <br />I � All facility employees have received the the required on-the-job training within the past year. X <br />16 All facilityemployees hired within the past 30 days have received the the required on-the-job training. X <br />Note: Any answer of "N" should be explained in the comment section on the following page, and will require <br />follow-up action. <br />WO#: 2263051 Page 1 of 2 September 2004 <br />