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Deesigriaited-Underground Storage Tank JUST) Operator <br /> Monthly Visual Inspection Checklist <br /> F <br /> acility Nanrre: Date: `f <br /> Address f f 2i Cade: <br /> Valley Underground Tank Moniitoring <br /> Mailing and Remittance Address: Valley Underground Tank Monitoring <br /> P.C. Box 91 <br /> Stockton„ CA 95201 <br /> Desi noted UST=9 erator Conducting the Inspection: q'A � <br /> ICC Cert:ifzca 4 3plzu Ex iration Date: - _ <br /> fL <br /> Signature. (fes Phone: 2 - <br /> Y=Yes, N=No, NA=Nut Applicable <br /> item IMon.itar-in Paneif'Alam Histo Y M NA <br /> Monitonno s stem is poweredon an in proper operatingmo e. <br /> Monitoring system is not currently showing any alarms or warnings. <br /> Alai-in history reporulog fort the previous month is available,and has been reviews <br /> by the Designated UST Operator. (Attach a copy of the alarm history reporViog if available). <br /> A uc i a arm fort the previous month as been respon e o appropriate y. <br /> 5 Sensors located in tank-top containment sumps nave not alarmedalBFMed in the past month. <br /> a ist a #an -top sumps where alarms occurred in[ e past month: <br /> Note:Sumps where an albrrn has occurred in the past month most be inspected unless a qualified service <br /> leclrniciair tasporided to, and properly addressed,the cause of the alarm. Attach documentation verifying <br /> a,ppropriale,service to this report_ !f sump inspection is required,reccud results in item 6, below. <br /> LIST System Inspection <br /> L an -top containment sumps are ree of water,debris;anazar ous.su stance. <br /> Sensors are located properly. Note:i/isualinspection of sumps are only required <br /> i n su„cps whore an aldrin has occurred in the past month for which there is no service record <br /> SumpLocation- S <br /> ump Location: �- <br /> urri ocation= X,ater, <br /> on. <br /> ump Location: on: <br /> pi containment structures are roe substance. <br /> Tank -Contents: an Contents: <br /> Tan - ontents: r - nalr <br /> an 4-Contents: <br /> _-A—Under-dispenser containment areas are ee a ris,an azar ous su stance. ensors <br /> are locatedroperty- <br /> -ispenser en <br /> ispser <br /> Dispenser ,fDispenser 11112 <br /> ispenserDispenser 13114 RNA <br /> is enser ispenser Paperwork inspection Y N <br /> Monitoring system certification has been cDmpletea within past months. <br /> Secnn a containment tests have been complete2 completewithin require time ra e_ /,- <br /> spil containment structure (bucket)testing was complet-ea within past year./,,-- <br /> IT <br /> ear. -- <br /> an lig tness- testing was compete wit rn require time rames. <br /> 71- me lig fitness testing was completed within requirea timeframe. <br /> er require m <br /> es ing ain enance was comp e e wi in require ime rame. (!ist maint. items below). <br /> est maintenance: <br /> esUm—aintenance: <br /> es maintenance: <br /> Facility Employee Training Y N NA <br /> 15 1-faci ity employees have received the require on-I a ao training int the past year. <br /> a city emp oyees ire wit in the past W days have received the require <br /> on-the-,job 'raining. <br /> Note: Any answer of"N" should be explained in the cornment section on the following page, <br /> and will require follow-up action. <br /> Pg. I'pf 2 <br />