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Desi 0d Underground Storage Tank (USAperator <br />Monthly Visual Inspection Checklist <br />25/2a09 <br />Facility Name: VVDER 1071A Date: 02/ <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: 4 <br />Item <br />0 <br />A <br />0 <br />4 <br />5 <br />5a <br />6 <br />P <br />Zip Code: 95215 <br />Expiration Date: 11/20/2009 <br />Phone: (209) 943-3213 <br />Y = Yes, N = No, NA = Not Applicable <br />%RM HISTORY Y I N N2 <br />Monitoring system is powered on and in proper operating mode. h <br />Monitoring system is not currently showing any alarms or warnings. X <br />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/logreport/log to this form i available.) <br />Each alarm for the previous month has been responded to appropriately X <br />Sensors located in tank -top containment sumps have not alarmed in the past month. X <br />- List all tank -top sumps where alarms occurred in the past month: <br />ALLALARMS DUE TO CONSTRUCTION AND TESTING BY BALCH PERTOLEUM. <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 verifying appropriate service to this report. <br />—A lf'sump inspection is required, record results in item 6, below. <br />Tank -top containment sumps are free of water, debris, and hazardous substance. Sensors are located properly. <br />Note: visual inspection (f sumps is only required in sumps where an (dorm has occurred in the past month for which there is no service record. <br />Y I I Y N <br />9 Monitoring system certiticat <br />10 Secondary containment tests <br />11 Spill containment structure <br />12 Tank tightness testing was a <br />L3 Line ti htness testing was cc <br />14 Other required testing/maint <br />Test/Maintenance: <br />Test/Maintenance: <br />has been completed within past 12 months. <br />to been cornoleted within the required timeframe. <br />ket testing was completed within the nnf ear. <br />Meted within the required timeframe. <br />leted within the required timeframe. <br />rice was completed within required timeframe.(Li; <br />01/16/2009 <br />01/16/2009 <br />01/16/2009 <br />X I / / <br />X I/ <br />test/maintenance items below.) <br />X / <br />X <br />X / <br />MONITORING PANEL / ALARM HISTORY y N <br />15 All facility employees have received the the required on-the-job training within the past year. X <br />16 All facility employees hired within the past 30 days have received the the required on-the-j'ob trainin 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# 2263994 Page 1 of 2 September 2004 <br />Sump Location: N/AStan <br />Location: N/A <br />Sum Location: <br />Setm Location: N/A <br />7 <br />Spill containment structures are free of water, debris, and hazardous substance. <br />Y <br />N NA <br />Y N <br />NA <br />Tank 1 - Contents: DSL <br />X <br />Tank 3 -Contents: NEW OIL <br />X <br />Tank 2 -Contents: DSL <br />X <br />Tank 4 -Contents: USED OIL <br />X <br />8 <br />Under -dispenser containment areas are free of water, debris, and hazardous substance. Sensors are located properly. <br />Y <br />N NA <br />Y N <br />NA <br />Dispenser 1 / 2 <br />X <br />Dispenser 9 / 10 <br />X <br />Dispenser 3 / 4 <br />X <br />Dispenser 11 / 12 <br />X <br />Dispenser S / 6 <br />X <br />Dispenser 13 ! 14 <br />X <br />Dispenser 7 / 8 <br />X <br />Dis enser 15 / 16 <br />X <br />9 Monitoring system certiticat <br />10 Secondary containment tests <br />11 Spill containment structure <br />12 Tank tightness testing was a <br />L3 Line ti htness testing was cc <br />14 Other required testing/maint <br />Test/Maintenance: <br />Test/Maintenance: <br />has been completed within past 12 months. <br />to been cornoleted within the required timeframe. <br />ket testing was completed within the nnf ear. <br />Meted within the required timeframe. <br />leted within the required timeframe. <br />rice was completed within required timeframe.(Li; <br />01/16/2009 <br />01/16/2009 <br />01/16/2009 <br />X I / / <br />X I/ <br />test/maintenance items below.) <br />X / <br />X <br />X / <br />MONITORING PANEL / ALARM HISTORY y N <br />15 All facility employees have received the the required on-the-job training within the past year. X <br />16 All facility employees hired within the past 30 days have received the the required on-the-j'ob trainin 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# 2263994 Page 1 of 2 September 2004 <br />