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do ib <br /> UNDERGROUND STORAGE TANK SYSTEM <br /> DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT <br /> Facility Name: Arch Rd.Arco AM/PM Inspection Date: 7 . e>:S <br /> Facility Address: 4855 South State Hwy. 99 City: Stockton, CA. 95215 <br /> Name of Designated US'r Operator Conducling Inspection: jQ 611 - <br /> luten 'othal Code u, cil Cerlificat. n No.: SZ _ yxpiration Date: 6 30_ <br /> 02 <br /> Si atwe: Phone: (916) 371-2380 ext. <br /> wn=Nat a aept,le <br /> tet» MONITORING PANEL/ALARM HISTORY Yesl No N/A <br /> 1. Is the monitoring system powered on and in o er o ratin mode? ❑ ❑ <br /> 2. IS themonitor system nut currently showing any leak Mulls? <br /> 3. 1s Ute Alarm History Report/log for the previous month available,and has it been <br /> reviewed by the <br /> Ll <br /> Designated UST Operator? (Attach a copy of the alarm history re roof;to this ins ectiort orm.) <br /> 4. Has each alarm for Ute revious month been res onded Ina ro riate / <br /> .Y:4A'i: 4Y 4 kQu : G..0 �•.. Sr :..:CGY 4, iT'. . .'n .�'ni <br /> UST SYSTEM INSPECTION <br /> 5. Are tank-top containment sumps free of water,debris,and hazardous substance? Nate:(fthd ans,wr to teem J was "Yes,"ship <br /> _ to tram 6.stumps N,hare an alarm has occurred in rho past month must ba inspearad if a qualified sarviee ioehnician has not responded to, and <br /> vrawiv addressed.the cause ofthe alarm.Documentation wriWm a ra rime service shoidd ba attached to this re orr. <br /> Yet No 1;'' Yet No <br /> Sum Location: Sun Location ❑ ❑ <br /> Swup Location: >!: SUTE 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 1 ID-89 -[] Tank 4 ID- <br /> Tahilc 2 ID-87 Quad Tank 5 11)- _ <br /> Tank 3 ID-91 Tank 6 ID- -- tl"�❑= <br /> 7. Are under-diqxmser contaimuent areas free of water,debris,and hazardous substance? <br /> Yes No N/A Yes I No I N/A <br /> Dispenser-1/2 -[]- Dispenser-9/10 _-❑ �❑ <br /> Dispenser-3/4 _ Dispenser- 11/12 <br /> Dispenser-5/6 _Dispenser -d <br /> Dispenser-7/8 Dispenser- 15/16- 17/18 <br /> 8. Leak detection is prgperly located within under-di user containment. <br /> Yes I No I N/A I Yes No N/A <br /> Dis user-1/2 Dis enser-9/10 - -E3- <br /> Dispenser <br /> -� <br /> Dis enser-3 1 Dispenser-11/12 <br /> Dispenser-5/6 Dispenser- 13/14 <br /> Dr r 7/8 Dns nser 15/16 17/18 <br /> m S C]S er Y •' :.::•<: .:.a:; r. .e. 'i/I- <br /> 15. <br /> ;.< PAPERWORK INSPECTION <br /> ye sN/A Date Done9, MonitoringSystem Certification was com leted witlhin the sl 12 months? 11-15-2007 <br /> 10. Line Leak Detectors were tested/certifled within the t 12 monis? 11-15-2007 <br /> 11. Spill bucket`-(z46-ainment structure)testingcoin leted within tile ast 12 enonths7 11-15.2007 <br /> 12. Line ti hthess tes!k completed within the required time frame? 12-11-2005 <br /> 13. Seeondarp eonlaimuent tests completed within the • uired titue$ante? 4-10-2008 <br /> 14, Edhatnced Leak Detection completed within the required time frame? <br /> Oth0taquired testis maintenance was completed within required time frame'? (List tGalmaintenance items below) <br /> Describe Test/MaintenanceAir Quality/Vapor recovery-(6 Months) ❑- PENDING <br /> Describe Test/Maintenance. I Li I in <br /> TACILITY EMPLOYEE TRAINING 1�tL Yes` No N/A <br /> 16. Have all facilityemployees received the required on-the rob uninil wrAn Uhe est ear? 1 12s El <br /> 17. ]-lave all facility employees hired within the past 30 days received the required on-Ute-lob training.? <br /> Note: Explain any"No" answers in the"Comments" section on the following page. 'rhose issues require corrective action from <br /> the UST owner/operator. <br /> UN-057-1/2 www.unidoes.org 926t05 <br /> E0/Z0 39tid 30N3NViINVW ZH 09t7ZILE9I6 89:EI 800Z/9Z/II <br />