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0 0 <br />UNDERGROUND STORAGE TANK SYSTEM <br />DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT <br />Facility Name: e-` hall Daft <br />r.mmyAdlin— <br />�S ..,rQCdr: <br />Name ofDml�ntd llST operator Conduuiag ltupection: <br />D"m Nunn <br />imavatioval Code Camwt7 C'ud8 do"No': <br />5238716 P.xpimtiov Datc: 7272077 <br />Si�mae: <br />Poor: (510) 894-7401 ext <br />item <br />wu-Nuw v. <br />MONITORING PANEL /ALARMHISTORY <br />L <br />Yes No N/A <br />. trodoT <br />Is the or------ s n o anc <br />3. <br />isthe m9' ' tet cuneotishown m Irak slams? <br />3. <br />is the Alms FGstory ReCoco oy fm the previous month avaRa1,10. and hash been revkwed by the Lj <br />Des d UST cram!! Aboth act rhe alma hbr .t/fo to riots arm. <br />i lion <br />fe'etel <br />4. <br />Has ..h alarm for the lour month Dern avdd to r p <br />UST SYSTEM IhSPECT70N - <br />S. <br />Ate rank -top caaamment sumps(ae ofwarer, dchis, undhasatkobl-Astmce7 Nan: I/rAa mrase�re den a.a, •Ya"wy <br />re dkw d. 3mgavAve rand /m aavrrdaNaPm.wrM.ora 6r bnp� Y. a�Frd r'. uu nawatei u.mi <br />Mie Nralarla f/oimrwrmM sinks aWdSemtadnilo Mtrm <br />Ya No :. Ya No / + <br />?� <br />S LOOadoR S Location: <br />Sum Location: 3 <br />6. <br />An spUl6uckeUs conuoinancat mocann tree Ofwaan debris and hazardous wbsreaeT <br />Ya No N/A Yn No N/A <br />Tads 1 ID - -mk <br />- <br />4lD0 01 F1 I <br />Tmk 3ID - Tank 51D- <br />Tavit 3 m - Taak 6 W - <br />7. <br />Ata aderdi aonremmrnt areas baa afwmer debri and hazardom svbstmceT <br />Yea NO N/A Yn No N/A <br />-12 Di ser -9/10 <br />' <br />eager -3/d D -11/l2 <br />D' ser -13/14 <br />' -7B Di ser-IS/16 <br />Ein <br />& <br />leak dWMtiO➢U lovld wknia mdcr er containment <br />Yes No N/A Yes No N/A <br />r-12 D- ser -9A0 <br />a-3/4 D' -11/12 <br />eour-13/14 <br />-7B D -15/16 <br />PAP ER WORK INSPECTION Y. No N!A Dere Dane <br />9. <br />Movitorn S Certifxatioa wu letd whhiv the t2 rvnmMT <br />10. <br />Line Leak Detectors wen tested/"trifid wilhm N< Pwt 12 months? <br />11. <br />S bucket wntammeatmuclue resin co ieredwithinthe =12m OM? 2_ <br />12. <br />Lme' ksW letd wi0wtthe tdmd time&mreT <br />13. <br />Sem thin lion rogavedtimefubul,? •ZI_ <br />14. <br />Edanmd Leak DetzNm letedwithiv the wired time ftame7 <br />I5. <br />Other u'vd ratio was Mad within time frww? rtmT/aafnburarwc hems blow. <br />De be Tes/Mamirnvice: <br />Describe Tat/lAnoulcamco: <br />FACIIa7'If EMPLOYEE TRAINING Yes No N/A <br />I6. <br />Hme all reel' em to eesrxaivd We oo-the-'ob - wJhin the <br />17. Haw all fui' a to hired Wilton the 30 days received Iter uirca av-1ho-' b 2 <br />••--. w.. dv •.. oeewm m. a,eumn. mason an tae 10110.9 P.S..'am Issues rrquvn mrrec[iv, lotion lits <br />the UST owacr/apcatm. <br />Irv-oa>-vs w.wyew«cva <br />9/lag4 <br />', V <br />MAR 0 7 2017 <br />ENVIRONMENTAL HEALTH <br />DEPARTMENT <br />