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Designated Underground Storage Tank (UST) Operator <br /> Monthly Visual Inspection Checklist <br /> acili Norrie: Date: <br /> F <br /> Facilit Address: <br /> Cit t zip Code: <br /> Valley Underground Tank Monitoring <br /> Mailing and Remittance Address Valley Underground Tank Monitoring <br /> P.O. Box 91 <br /> _ Stockton, CA 95201 <br /> UST noted USerator Conductingthe Inspection. / ' _ r1 fl <br /> ICC Certifica,t XX4 Ex ifation Date. <br /> Sit nature: "r . Phone: 11_13_206�­ <br /> 19-649-8-956 <br /> - <br /> Y=Yes, N=No, NA=Not Applicable <br /> Item <br /> Monitoring Panel/Alarm History Y I N NA <br /> 1 Mon+t�rrrig system is powered on and in proper operating mo e. <br /> orittoring system is not currently showing any alarms or warnings. , <br /> atm history rej)orulog fort the previous month is availabie,and Eas een reviews <br /> by the Designated UST Operator. (Attach a copy of the alarm history report/log if available). 4. <br /> 4 �je i a arm or-t e previous month as been responded to appropriate y. <br /> 5 sensors located in tanK-K)pcontainment sumps have not alarmed in the pas mon <br /> a rst a tan -lop sumps where alarms occurred int the past mons <br /> lvotu: sumps wftere an alaror/)as occurred in the past month muss he inspected unless a qualified service <br /> lochmuian responded to, and properly addressed,the cause of the alarm. Attach documentation verifying <br /> apprUpriErlc service to this report" if sump inspection is required;record results in item,45, below. <br /> UST System Inspection <br /> n -top containment sumps are ree ot water,debris,and hazardous substance. <br /> Sensors ate located properly. Nole:Visual inspection of sumps are only required <br /> ill st..iris wilt), an Marin has occunud in the past month for which there is no service record <br /> AN " <br /> ump ocation: ra,,, <br /> on:urn ocatron: on: <br /> SO ump ocatron: At ' <br /> Location" <br /> containment structures are free , S,asubstance. <br /> an - ontents: �r an Contents: .rte <br /> Tank - Contents: � Y --- an 4-Contents: rr <br /> n er- dispenser containment areas are tree ot water,debris, and hazaFa­o­us_`s_uFs_tance. Sensors <br /> are located properly- <br /> 6'ispenser rjUspenser9110 <br /> rspenser IDispensef <br /> Isper�iser - Ispgnser 4 - <br /> iS enser r' Ispenser <br /> Paperwork Inspection Y N NA <br /> onitonng system citric icatron as been complete within past months. <br /> Secon aIFYcontainment tests have been completed within require time rame_ <br /> pr containment structure uc et testing was completed within past years <br /> an ttg Ines testis was cornpleted within required time fames. <br /> Line tightness testing was compit;nuu W11.11111 icquilcu Ilene tame. <br /> Other required testinglillom enance was comp e e wr rn require Ime rame. (Ust maint. items below). <br /> estmaintenance: <br /> est�mtenance: <br /> es maintenance: <br /> Facility Employee Training Y N NA <br /> \ AIMEE Ity ernp oyees ave recerve the require on-the-jobliaising in the past year. <br /> i-facility employees tre within the past ays ave received t require <br /> an-the-ob t'aining. <br /> Note: Any arrjswer of "N" should be explained in the comment section on the folicfwing page, <br /> and will require fallow-up action. <br /> pg. F of 2 <br />