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Designated Underground Storage Tank (UST) Operator <br /> Monthly Visual Inspeption Checklist <br /> Facility Name: /, ,, 8 ZIf. ��- , �,-� Hate: +? C- r , <br /> Facility Address: <br /> Cit Zi Code: 7 " <br /> Valley Underground Tank Monitoring <br /> Mailing and Remittance address: Valley Underground Tank Monitoring <br /> P.O. Box 91 <br /> Stockton, CA 95201 <br /> Designated USI- O erator Conducting the Inspection: Lj 0,) ,r,, i*-V"C:V__(zq {- <br /> ICC Certific XX414101Ex iratior Qate: _ <br /> signature- ' I L.4 jPhone: 209-649-8956 <br /> Y=Yes, N=No, NA=Not Applicable <br /> Item Monftoring Paneft Alarm Histlory Y N NA <br /> AA©nitonnc. s stem rs <br /> powered on and in proper operating mode. <br /> )rlltorlrrg system is not currently showing any alarms or warnings""" <br /> grin hiblury repo og Tort the previous month is aval a e,aP : 's been revlewe <br /> by the Designated UST Operator. {Attach a copy of the alarm'history repoazloy if avajlab}e). <br /> 4 ac)a arrn or t e previous month has been responded to ppropnate y. rd <br /> 5 sensors located in tank-lop conialriment sumps have not al'awLealoinepast Month. <br /> —9-a— rsf a11 tank-top sumps w -ere alarms occurred in the pall mon 4 0 r <br /> Nola: Surrips ctirhere an alarm,has oCcurred in,the past monfh must be"ectad unless a qualified service <br /> tochnicirirr rrisponded to, and prnpagy addressed,the cause of the aiarm,.`Attach"urnentation vantyinrd <br /> at proprimt service io this report_ if sump inspection is required,racord,resulls n i 6T,6, below. <br /> LIST:System Inspection <br /> n c-top containment sumps are ree o water, errs;an <br /> (n, up substance. <br /> Sensors are located property. (dote:visual inspection of surrrps len,t3bilrequired <br /> i n sL_:ws wt,ryre an atarrri has occurred in the past h for which re is no service record <br /> ump ocation: SumpLocation: <br /> �ulT1 occ3tlQf1. ump Location: TO <br /> ump ocatlon; / um oca on:pi containment structures are ree O Water, a cis,an agar s su sta ce.I NA I <br /> an - ontents: � an - onlents: <br /> 1 an ontents: 1r ._� . an 4- aritents: <br /> n er- rspenser conta.inment.areas are tree D water,debris,an azar ous su stance. ensarsl <br /> die located operIV. <br /> Drspensei' rspenser <br /> rspenser rspenser <br /> rspenser f Is nser -' <br /> is eraser ispenser r <br /> Paperwork Inspection Y N NA <br /> onitarrng system cert) rcatron as een compete wit lin past mora- s. <br /> IF Secon a containment tests ave een camp eie wi in require time tame. <br /> pin containment structure uc et testing was compete within past year. <br /> ailg -Hess tesin was Completed within reque Lime fames. <br /> t <br /> ine irg tness testing was camp ete wit in required time came. <br /> 01her require es ing main enance was comp e e within require ime rams. (List maint. items be)ow)_ <br /> est ma+ntenance: <br /> es7R18intenance: <br /> es maintenance: <br /> Facilit Employee Training Y N NA <br /> rV aci dy ern(a oyees ave receive t e require on-t a-io training in t e past year. r <br /> 1 a is rty emp oyees hired within the past ays have received the require <br /> ori-Itie-ob f-wining. <br /> Note: Any answer of "N" should be explained in the comment section on the following page, <br /> and will require fallow-up action. <br /> Pg. t'pf 2 <br />