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Designated Underground Storage Tank (UST) Operator <br /> Monthly Visual Inspection Checklist <br /> Facility Name: COSTCO 0658 j Date: 2/10/2015 <br /> Facility Address: 3250 w.Grsaume Rd <br /> City:Tracy Zip Code: 95377 1 <br /> Designakd UST Opmwr Conducting the Inspection: Gabriel Martin <br /> In-'em <br /> ode Council Certification 8: 8260320 Expiration Date: 6/5/2016 <br /> Signature: Phone: (949)460-5200 <br /> Nn,NA-Not Applicable <br /> Item MONITORING PANEL/ALARM HISTORY y 1q NA <br /> 1 Monitoring System is powered an and in proper operating marc X <br /> 2 Monitoring system is nut currently showing any alarms or warnings. X <br /> 3 Alarm history reportflog for the previous month is available,and has been reviewed by the Designated UST X <br /> Operator. (Attach a copy of the alarm history reporVlog to this form if 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 alzrmed in the past month. X <br /> 5a - List all talc-top sumps where alarms occurred in the past month: <br /> 2/7:8711 F111 Somp-Hydro <br /> Nnte Sonya wkem an alum has u o,,rcd in Ar past month nuor Ire motrcird uttese a qualgied semicv twhnidan responded to.and pevparly <br /> adsbereed,rke eaare ofthc alarm Altarh darumrnmtiml wr fcilta appropriate aer.ite to this report.Ifsump inspection is mquiod,record rmulu <br /> In item 6,below <br /> UST SYSTEM 1\SPECTION <br /> 6 Tank-top containment sumps arc free of water,debris,and hazardous substance. Sensors are located properly. <br /> Npe Nuallnrtm-non y rrnpt u e.MY.ryrnN nn,mru rhen an atamr Aa.rc.urmd in tkrpm muMA fo.rlirh rArm n n rervuere....M <br /> Y Y N <br /> Sump Location: "'A Sump Lr imorc N'• <br /> Sump Location: "'A <br /> Sump Location., "`A <br /> Sump Location: wA i Sump Location: <br /> 7 Spill containment structures are free of water,debris,and hazardous substance. <br /> Y !n I V N NA <br /> Tank-877VX Tartk9/ X <br /> Tank-87S X Tank-Additive Tank X <br /> 8 Under-dispenser containment areas arc free of water,debris,and hazardous substance. Sensors are located properly. <br /> V N NA V N NA <br /> Dispenser-//2 X Disperuer-9/10 X <br /> Dispenser-314 X L I Dispenser-11/12 X <br /> Dirpenserv516 X <br /> Dispenter-7/8 X <br /> PAPERWORK INSPECTION Y N NA DATE DONE <br /> 9 Monitoring system certification has been completed within past 12 months. EBX E9/25/1410 Secondary containment tests have been completed within the required timcl'mX11 Spill containment swcture(bucket)testing was completed within the past year12 Tank tightness testing was completed within required timeframe. Xl3 Line tightness testing was completed within required timeframe. X <br /> 14 Other required testing/maintemmuc was completed within required fimcfrxme.(List tesUntaintenmcc items below) <br /> TestlMaituenance. X MA <br /> TestLMainlenance: X WA <br /> TestlMaintenance: X N/A <br /> FACILITYEMPLOYEE TRAINING Y N I NA <br /> 15 1 All facility employees have received the required on-the-job training within the past year. X <br /> 16 1 All facility employees hired within the past 30 days have received the required on-the-job training. X <br /> Note: Any answer of"N^should be explained in the comment section on the following page,and will require follow-up <br /> action. <br /> Page I of 2 <br />