Laserfiche WebLink
UNDERGROUND STORAGE TANK SYSTEM <br /> DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT <br /> ~-- Facility Name: Inspection Date: LoqI20 1 O <br /> Facility Address: L{p 55 S. City' <br /> Name of Designated UST Operator Conducting Inspection: RobertBarnhart <br /> Intimation cil Certification No.: 5252540-UC Expiration Date: 12/23/2011 <br /> Signature: Phone: <br /> t�- (209)604-9336 ext. <br /> N/A- otAonlientile <br /> Item MONITORING PANEL/ALARM HISTORY Yes No N/A <br /> 1. Is the monitoringsystem powered on and in proper o eratin mode? <br /> 2. Is the monitoringsystem not current) showingan leak alarms? <br /> 3- Is the Alarm History Report/log for the previous month available, and has it been reviewed by the El <br /> Designated UST Operator? Attach a co o the alarm histo re ort/[o to thrs rw action orm. <br /> 4. Has each alarm for the revious month been responded to a ro natal ? <br /> UST SYSTEM INSPECTION <br /> 5. Are tank-top containment sumps free of water, debris,and hazardous substance? Note:lfthe annver to Item 4 was"Yes."skip <br /> to Item 6. Sumps where an alarm has occurred in the past month must be insImoted if a qualified srr hx technician has not responded to, and <br /> property adtimssed,the cause of the alarm.Documcntatton veroing gegropriate servtcy should be attached to this mporL <br /> Yes I No I" Yes No q <br /> Sum Location: Sum Location: 4 <br /> Sum Location: Sum Location: <br /> 6- Ares ill buckets containment structures free of water, debris, and hazardous substance? <br /> Yes No N/A Yes No N/A <br /> Tank I ID— 4zTank 41D— <br /> TankI Lj El Tank 5 ID— <br /> Tank31P— /1G rYkt. I b4 Lj Ll Tank 61D- <br /> 7. Are under-dis nser containment areas free of water,debris and hazardous substance? <br /> Yes I No I N/A t 1r JANCI Yes No N/A <br /> -Dispenser 1/2 ❑ Lj I Dispenser-9/10 El <br /> -Dispenser 3/4 Dispenser— 11/12 El El <br /> -Dispenser 5/6 Lj I Lj j Dispenser- 13/14 <br /> Dispenser—7/8 Lj I U I Dispenser— 15116 <br /> 8. Leak detection is eroperly located within under-dis enser containment. <br /> Yes NoN/A livo f t'S Yes No N/A <br /> -Dispenser- 1/2 ❑ Dis a ser-9/10AC 0 <br /> -Dispenser-3/4 Dispenser— I I/12 <br /> Dis enser-5/6 Dispenser- 13/14 <br /> Dis enser-7/8 ❑ Dis enser- 15/16 <br /> .. .y,. ,. <br /> PAPERWORK INSPECTION Yes No N/A Date Done <br /> 9. Monitoring System Certification was completed within the past 12 months? t—p <br /> 10. Line Leak Detectors were tested/certified within the past 12 months? I LHJ liz— 31-0 <br /> 11. Spill bucket containment structure)testing completed within the past 12 months? L—31—p <br /> 12. Line tightness testing completed within therequired time frame? LZI <br /> 13. <br /> Secondarycontainment tests tom feted within the r uired time frame? p <br /> 14. Enhanced Leak Detection completed within the required time frame? <br /> 15. Other required testing/maintenance was completed within required time frame? List testImaintenance items belaw.) <br /> Describe Test/Maintenance: D,/9/ fD <br /> Describe Test/Maintenance: <br /> FACILITY EMPLOYEE TRAINING Yes I No I N/A <br /> 16. Have all facili employees received therequired on-the-job training within the past ear? <br /> 17. Have all facili em to ees hired within the past 30 days received the required on-the-'ob trainin .? <br /> Note: Explain any"No"answers in the"Comments"section on the following page.Those issues require corrective action from <br /> the UST owner/operator. <br /> UN-057.12 www.unidocs.org 9/26Ns <br />