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10878 N. Hwy 99, Stockton, CA 95212 Record ID PR0231598 <br /> 4/25/2016 PHOTO#10 <br /> November 2015 D.O report with incorrect test dates for MSC, LD and Spill containers <br /> UNDERGROUND STORAGE TANK SYSTEM ; <br /> „ DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT <br /> .....- <br /> r FAST$Eq Ins ecfion Date. I <br /> t, da,-�a tns. --SY p November 25, 2015 <br /> 10878N HWY gg Cipa STOCTON CA. <br /> r 110.-ir,n3ted UST <br /> 3 OPetntor Conducting Inspection: Cason Haase <br /> I Into maiio til CrW• unN Qrrnhcation No.: — 'gym <br /> �enalne, 8165490-UC Expiration Date: y6/20'17 <br /> _ 1szm1 <br /> Phone: (530)749-9892 ext. 'y'azp <br /> Item vlw=Nets IA <br /> MONITORING PAN EL RM IIISTOR Yes No NIA �. - I`g� <br /> f Is Itr n morin R <br /> •s seem powe d d -tnoI[t I-- <br /> 1.tlpt mi niRxim'a sleet not currenti, shown an leak alarms'lde? ❑ iti 'Lim <br /> 1'theAldan Hisros�poUriog fix the previous month available,and has it been reviewed by the a 3t <br /> Dcsienatcd llSTO orator° P \I! <br /> J. Has each al IAna h 'responded <br /> rhe nl I r 6 -p t/phis ins "non form.) <br /> amp for the revmus month been res onded to a in riatel n <br /> 'lrc tanA to UST Sl STEM INSPECTION r �'t <br /> p con[ammunt sumps Tree oC water_debrie and hazardous <br /> W' an alarm substance? N11,'If l)"c"d"'i 1e li d <br /> r /mm 6 Sue ,eperc ba'o erred in U,e rzchn t.an r <br /> ias nut esponded m,and E <br /> rn vh adl esved rare<rnree n roe uh,o-, pa-rnnenral e�:��rn3 mast M1r me,¢crtd 1 u yea Ii <br /> rovriomrery,ceshuuldhvormchcdmpusre orr_ Yes No I 1 <br /> r I <br /> Sum p Location: UNLEADED Ycs Nn I <br /> �) <br /> ® ❑ Sump Location:UIESEI. <br /> Sum Location: PREMIUMI ZJ i ❑ ISum Location: <br /> 6. Are spill buckets(containment structures)free of water,dehris,and ha><vdous substance? , <br /> Yes No N/A Ycs No NIA _ <br /> Tank I ID-UNLEADED ❑ ❑ Tank 4 ID- ❑ .( <br /> I Tank 2 ID-PRFA41UA4 ❑ Tank 5 ID <br /> Tank J ID-DIESEL ® ❑ Tank G ID- <br /> ' Arc under-dispenser containment areas free of water,debris,and hazardous substance? <br /> f I YYes No NIA_ <br /> Yes No N/A <br /> Dispenser_ 1/2 ❑ <br /> ® ❑ ❑ )sen � <br /> Dispenser-14 ® ❑ <br /> I <br /> Dis enser-5/6 Dis enser- 11/10 <br /> _ ❑ �_J <br /> _❑ Dispenser- 13/14 <br /> Dispenser-7/8 ® ❑ ❑ Dis enser- 15/16 � Y <br /> i S. Leak detection is properiv located within under-dispenser containment. <br /> Yes No N/A __. Yes No NfA � '• t <br /> Dispenser- I/2 ❑ Dispenser-9/10 ❑ <br /> Dispenser-3!4 ® Dis enser- 11/12 _ ❑ <br /> Dis enser 516 ❑ Dispenser- 13/14 <br /> Dispenser-7/8 M ❑ ❑ Dispenser- 15116 _ ❑ ❑ ❑ <br /> ( PAPERWORK INSPECTION Yes Nu —1) It:Dane <br /> 9. Monitoring Sgstem Certification was completed within the past 12 months? ® _❑ ❑ 412112015 <br /> 10 i Line Leak Detectors were tested/certified within the past 12 months? 412112015 <br /> 11. Spill bucket (eontainnienr structure)testing completed within thepust 1?Flmonths? ® [_] 4/2112015 <br /> 12. ' Linz tiehiness tcstin�' cont leted within the ret uued[unz firarc? - - ❑ ❑- [T'J <br /> -� P. -- —1 -- I <br /> 3. Seconda containment tzsls cont)f led within the required time linma? 413012015 <br /> i.I . C..6..o.•_ri I —L rlatxlhs,,,r,mnl,n•rl within Ihr ranuirrd Iinu• Gaun•? t 1 — <br /> Fatinah Zareef, REHS Page 10 of 16 <br />