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Rp'r 30 07 08: 29a • • P• 1 <br /> UNDERGROUND STORAGE TANK SYSTEM <br /> DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT <br /> FacilityWarne: Jahant Food&Liquor Inspection Date: 09-22-2006 <br /> Facility Address: 24323 Hwy 99 City: ACarnpo. CA 95270 <br /> Name of Design ed UST Operator Conducting inspection: John Starnes <br /> Intematio onoCertifiratioo 5261292-UCP �Date: 06-02-2007 <br /> Signat Phone: (916)371-2380 ext <br /> N1A-N6tAjkpHmhk <br /> Item MONITORING PANEL/ALARM HISTORY Yes No N/A <br /> 1. Is the mcnit*nm system.powered on and in proper operwing mode? m I El 1-1 <br /> ? 1s the amnituring System not currently Showing any leek ala ms? <br /> Ell 17- <br /> 3. Is the Alarm history Rupon/log for the previous mouth available,and has it been,reviewed by the <br /> -0- <br /> Desagoated UST Opwaue Attach a copy ojrdw dorm by report1log to 11th Impeeiron orm <br /> 4. Has each Norm for the previous month beenoaded m <br /> .....:.nw•. .n.�2-..aK' -+nKZa+�sa� y eu.- .m.. ..I-. .sac •^`trro Wit..:' .�"u..:�.::.✓.:\.�.s:.. <br /> LIST SYSTEM INSPECTION <br /> 5. Are tank-top containment 6tmeps fitie of water,debris,and hazardous substance? Nok.,J/ak amwer to lum 4 aur"YeA,",kip <br /> m Geeu Q SwW vdxm an alarm Aw oeearrrd in me pan ewnth matt M mot ead Uu g,,tUkd, ji Cd�mt k=nae m*aewd to.and <br /> ,wwedy addrc zt da rise Qfthv,4Wm Damaatbn -!qg ErkxrvirarAaWd keamd.d m dd: <br /> Yes NoI Yes I Nom <br /> Sump Location: <br /> 3f°�Fi. Sum l.ocatios �+�a''�r <br /> Sump Location- �.�•::°.. $ <br /> .g: <br /> 6. Are Spill bucketsronrMihraem strochlres free of water,debris and hazardous substance? <br /> Ya No WA I <br /> Yes No N/A <br /> Tank 1 ID-87 Talc 4 ID-DSL 0 <br /> Tank 2 ID-89Tank 5 ID- <br /> Tank 3M-91 Tank 6'ID- - <br /> 7. Are undtrdis cootdinn at areas free of water,debris,and hazardous subsUmee? <br /> Yes No N/A Yes No N/A <br /> Dispenser-1/2 Dis -9/10 <br /> Dispenser-3/4 -11112 <br /> Dispenser-5/6 -13/14 Cal <br /> Dispenser-7/8 1 29 1 LJ I U I Dis -15116 <br /> 8. leak deluction is rl located within under dispenser containment. <br /> Yrs NO <br /> N/A Yes No N/A <br /> Dispenser-1/2 Di -9/10 <br /> D' -314 D' -11/12 <br /> Di -5/6 ARCH Dispenser-13/14 <br /> Dispenser-7/8 N I LJ I UD' -15/16 <br /> PAPERWORK INSPECTION (Ya :No� NIA Date Done <br /> 9. MonWring System Certifimtion was completed within the past I2 inorMhs? ® 05-11-2006 <br /> 10. Line Leak Dtxeotors were tested/c ettified within the 12 mon,du? 05-11-2006 <br /> 11. Sill bucket containment srrucwro res" feted wid»n the t12-mouth ? <br /> 2g 1 0 1 u 1 05-11-2006 <br /> 12. Line Lightness testing completed within the r uired time frame? Ll I El 10 1 <br /> 13. Secondary containment tests completed within the required time frame? 09-27-20D5 <br /> 14. Enhanced Leak Detection.completed within the required time Name? <br /> 15. Other raguirCd testis maintenance was completed with=requwed time frame? (List itu/mdruenance items bylaw.) <br /> Desen"be TeSV�aieeanaM1-o•Air Q St 27 a30 ® 10-1&2005 <br /> Descrlba Test/Maiateaaace: <br /> FACILITY EMPLOYEE TRAINING Yes No N/A <br /> 16. 1 Have all facility employees received the9�4'red ort-djob u2inin within the act <br /> 17. 1 Have all fmili em to ees hired within deo past 30 dwys rmcivod the lNuired tin- ob ? <br /> N'oto: Explain any"No"answers in the"Comments"section on the following page,Those issues require corrective action from <br /> the UST o*=/opentor. <br /> VN497-r/2 www.midomam 9/Z6/115 <br /> 33N3Nt11INCW ZS BSbZtLE916 0191 LW/LZ/09 <br />