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f ✓�4 <br /> Designated Underground Storage Tank (UST) Operator <br /> Monthly Visual Inspection Checklist <br /> Facility Name:ConocoPhilli s Site#2708671 Date: 12/21//06 <br /> Facility Address:8606 Thornton Rd. <br /> City:Stockton Zip Code:95209 <br /> Designated UST Operator Conducting the Inspection:Julie Lee <br /> International Code Council Certification#:5248777-UC Ex iration Date: 12/14/2006 <br /> Signature: - °� °� Phone:(510)245-5218 <br /> Y=Yes,N=No,NA=Not Applicable <br /> Item MONITORING PANEL/ALARM HISTORY Y N INA <br /> " r_ <br /> I Monitoring system is powered on and in proper operating mode. x <br /> 2 Monitoring system is not currently showing any alarms or warnings. x <br /> 3 Alarm history report/log for the previous month is available,and has been reviewed by the x <br /> Designated UST Operator. Attach a copy of the alarm history report/logreport1log to thisform i available. <br /> 4 Each alarm for the previous month has been responded to appropriately. x <br /> 5 Sensors located in tank-top containment sumps have not alarmed in the past month. x <br /> 5a _ List all tank-top sumps where alarms occurred in the past month: <br /> N/A <br /> Note:Sumps where an alarm has occurred in the past month must be inspected unless a qualified service technician responded to,and <br /> properly addressed,the cause of the alarm.Attach documentation verifying appropriate service to this report. <br /> I sum in ection is re uired,record results in item 6,below. <br /> UST SYSTEM INSPECTION <br /> 6 Tank-top containment sumps are free of water,debris,and hazardous substance. Sensors are located properly. <br /> Note:Visual inspection o sums is only required in su s where an alarm has occurred in thepast month or which there is no service record. <br /> Y N Y N <br /> Sump Location: Sump Location: <br /> Sump Location: Sum Location: <br /> Sump Location: Sumv Location: <br /> 7 Spill containment structures are free of water,debris,and hazardous substance. <br /> Y N NA Y N NA <br /> Tank 1—Contents:87 x Tank 3—Contents:91 x <br /> Tank 2—Contents:89 x Tank 4—Contents: <br /> 8 Under-dispenser containment areas are free of water,debris,and hazardous substance. Sensors are located properly. <br /> Y N NA Y N INA <br /> Dispenser 1/2 x Dispenser 9/10 <br /> Dispenser 3/4 x Dispenser 11/12 <br /> Dispenser 5/6 Dispenser 13/14 <br /> Dispenser 7/8 777,77, Dispenser 15/16 <br /> .... .. .... ....�.W,77 ... ._ <br /> PAPERWORK INSPECTION Y N NA DATE DONE <br /> 9 Monitoring system certification has been completed within past 12 months. x <br /> 10 Secondary containment tests have been completed within the required timeframe. x <br /> 11 Spill containment structure(bucket)testing was completed within the past year. x <br /> 12 Tank tightness testing was completed within required timeframe. x <br /> 13 Line tightness testing was completed within required timeframe. x <br /> 14 Other required testing/maintenance was completed within required timeframe. List test/maintenance items below. <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> MIM `r'j �€t >''('e'r'rc 7tx; ,'0";i <br /> FACILITY EMPLOYEE TRAINING Y N NA <br /> L1a <br /> acilit em to ees have received the re uired on-the-'ob trainin within the ast ear. x <br /> acili em to ees hired within the ast 30 da s have received the re uired on-the-'ob trainin . x x <br /> Note: Any answer of'IN"should be explained in the comment section on the following page,and will require <br /> follow-up action. <br /> Page 1 of 2 <br />