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UNDERGROUND STORAGE TANK SYSTEM DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT Facility Name: AiWO Inspection Date: C O Facility Address: H rs% S . Clty C J Name of Designated UST Operator Conducting Inspection: RobertBarnhart internatio de ouncil Certification Noi 5252540-UC Expiration Date: 12/23/2011 Signat e: Phone: (209) 604-9336 ext. N -NotApplicabl, Item MONITORING PANEL/ALARM HISTORY Yes No I N/A 1. Is the monitoring system powered on and in proper operating mode? 2S L1 I El 2. Is the monitoring system not currently showing any leak alarms? 3. Is the Alarm History Report/log for the previous month available,and has it been reviewed by the Designated UST Operator9 Attach a copy of the alarm history report/logreporillog to this ins ection orm. 4. Has each alarm for the previous month been res onded to appropriately? . UST SYSTEM INSPECTION 5. Are tank-top containment sumps free of water,debris,and hazardous substance? Note:if the answer to Item a was "res,^.skip to Item 6. Sumps where an alarm has occurred to the past month must be inspected if a quallfted service technician has not responded to, and preverly addressed,the cause o the alarm.Documentation verifying a ro riate service should be attached to this re rt. Yes I No I I Yes No ;_-;in'r Sump Location: Sump Location: I U LJ Sump Location: Sump Location: I ❑ I ❑ 6. Ares ill buckets containment structures) free of water,debris,and hazardous substance? Yes No N/A I Yes I No N/A Tank 1 ID— Tank 4 ID— EF El Tank 21D— Tank 5 ID— Tank Tank 6 ID— 7. Are under-dispenser containment areas free of water,debris and hazardous substance? Yes No N/A I Yes I No I N/A Dispenser— 1/2Dis enser-9/10 Dispenser—3/4 ❑ ❑ Dis enser— 11/12 ❑ 1 El Dispenser—5/6 1 Dis enser- 13114 Dispenser-7/8 I Dispenser— 15116 1 El I El S. Leak detection is properly located within undeo-dis nser containment. 4 1 T Yes No N/A t -7 ( Yes No N/A pis enser- 12 I Pq I LJ I U I Dispenser-9/10 Dispenser—3/4 Dispenser— 11/12 0 El I El Dispenser—5/6 JZ 1 ❑ 1 ❑ I Dispenser— 13/14 W ❑ Dispenser—7/8 1 JA I ❑ I Lj I Dispenser— IS/16 1z 0 1 ❑ PAPERWORK INSPECTION Yes I No N/A I Date Done 9. Monitoring System Certification was completed within the east 12 months? 2—31--O ct 10. Line Leak Detectors were tested/certified within the past 12 months? t 2—3 t—0 11. Spill bucket containment structurej testing completed within the past 12 months? El I El 12. Line tightness testing com leted within the required time frame? 13. Secondary containment tests completed within the required time frame? —!O 14, Enhanced Leak Detection completed within the required time frame? ❑ 15. Other required testing/maintenance was completed within required time frame? (List res maintenance items below.) Describe I est/Maintenance: ❑ ❑ ' 2 f Q�!o Describe Test/Maintenance: FACILITY EMPLOYEE TRAINING Yes No N/A 16. Have all facility employees received the required on-the-job training within the past ear? 17. Have all facility employees hired within the past 30 days received the requiEed on-the=ob training.? Note: Explain any"No"answers in the"Comments"section on the following page.Those issues require corrective action from the UST owner/operator- UN-07-112 www.unidocaorg 9t2w,