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Designated Underground Storage Tank (UST) Operator <br /> Mondfly Visual Insoection Checklist <br /> Facility Narrte: date: <br /> } <br /> Facility Address: / z <br /> Cily- '64Zi Code: <br /> Valley Underground Tarok Monitoring <br /> Mailing, and Remittance Address: Valley Underground Tank Monitoring <br /> P.O. Box 91 <br /> Stockton, CA 95201 <br /> Uez�i Hated t ST O erator Conducting the Inspection: P6' <br /> TCC Certi i e 4 iratio <br /> ft n Date_ <br /> Sit nature: Phone: 209-649-8956 <br /> Y=Yes, N=No, NA=Nuc Applicable <br /> Itern � Monitorin Panel/Alarm Histo Y N NA <br /> Kortori_ <br /> I �ing system is powered on and in proper operating mode. <br /> ui iilorntc} system is not current y s owing any a arms or warnings. <br /> arm hi5l.ory repowleg ort a previous month is available,and has been reviewed <br /> by the Designated UST Operator_ (Attach a copy of the alarm history rieporWog if available). ! <br /> 4 Fneh a arm for the previous month has been responded to appropriate y. <br /> 5 Sensors located in tan -top containment sumlYsWavemot alarmed in the past month. <br /> a List all tan -top sumps where alarms occurred in the past monft <br /> Noli:r: suri+ps wliere an aiarrri has occurred in the past month most be inspected unless a qualified service <br /> technician responded to, and properly addressed, the cause of"alarm. Attach documentation verifying <br /> apprrspriwa- service to this report_ if sump inspection is required,record results in item 6, baiow. <br /> UST System Inspection <br /> J�jrr -top containment sumps are tree ot water,debris,and hazafdous su stance. <br /> Sensors are located properly. Note:Visual inspection of sumps are only required <br /> S4. p5 wi,are an rAlarrn has occurred in the past mOnih for which lliere is no service record <br /> umpLocation: Sump ocation: <br /> wn ocalian_ SurnpLocation: <br /> ump ocation: urnp Location. <br /> pill containment structures are free o water, a ns,and hazardous substance. <br /> an - ontents: an - ontents: <br /> Tan ontents: an 4 ontents: <br /> lJ comer- - ispenser containment areas are ree ot water,debris,and hazara–ous su stance. Sensors <br /> are located prDperlY. <br /> Dispenser Dispenser 97 10 / <br /> Dispenser ispenser 11112 / <br /> }ger ] / Dispenser 13114 / <br /> is onst;rDispenser 15/16 <br /> Paperwork Inspection Y N NA <br /> onitoring system cert) ication as been compete within past months. <br /> econ a <br /> rcontainment tests ave been compete within require time rame. <br /> pi containment structure (Bucket)testing was comp ete within past year. <br /> 12 <br /> an tig tness tesUn was compete within require lime fames. <br /> ire tiQ (Hess <br /> testing was completed wit in require lime-fame. <br /> other required lesting1maintenance was comp e e wi in required Limetrame. (List maint. items below). <br /> est maintenance: <br /> esffm—aintenanee: <br /> es maintenance: <br /> Facitit Employee TrainingY N NA <br /> aci ity emp ogees have received the require on-ta-jo training in the past year. <br /> facilityemployees ire wit in t e past days have receive t require <br /> oft-the-Job !wining. <br /> Note: Any answer of"N" should be explained in the comment section on the folio ing page, <br /> and will require follow-up action. <br /> Pg. T pf 2 <br />