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Designated Underground Storage Tank (UST) Operator <br /> Monthly Visual Inspection Checklist <br /> FacilityNamc� COSTC00658 <br /> Facility Address: 3250 W-Graadlne Datc: 3/18/1015 <br /> Rd <br /> City:Tracy Zip Code: 95377 <br /> Designated UST Operator Conducting the Inspection: Gabrld BLrtfa <br /> international Code Council Certification q: 8260320 Expiration Date: 6/5/2016 <br /> Signature. Phone: (949)460-5200 <br /> Y-Yrs,N-Nq NA—Not Appacabit <br /> Item MONITORING PANEL/ALARI1f HISTORY <br /> Y N NA <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 re log for the previous month is available,and has been reviewed by the Designated UST X <br /> Operator. (Attach a copy of the alarm history report/log to this form if available.) <br /> 4 Each alarm for the previous month has been responded to appropriately X <br /> 5 Sensors located in hank-top containment sumps have riot alarmed in the past month, X <br /> Sa - List all tank-top sumps where alarms occurred in the past month. <br /> /r'Ofe .4taepr%hers an alarm has occurred m the parr mond,cowl be impecled nmess a goahftrd service technician responded lo,and properly <br /> addressed rhe cause of the alarm.Attach documemanon rerfiaig appropriate senwe to this report if sump uupeenon is required.recon)msula <br /> in item 6,be/aa <br /> UST SYSTEM INSPECTION <br /> 6 Tank-top containment sumps are free of water,debris,and hazardous substance. Sensors are located properly. <br /> ,gorc1"nW,mreMon ofruyano^N rrgrvrcdin tveyuwMrr an alarm her xawrtdm Ar iTonih <br /> pay for rhirh ar.ruroun,rr nroN <br /> N <br /> Sump LOCQ(i0a: "'" '�+ Sump Location: "'s *,*. <br /> Sump Location: K'^ i SumpLocmion: VA u <br /> Sump Location: 'c'^ Sump Locotiom <br /> 7 Spill containment structures are free of water,debris,and hazardous substance. <br /> Y N NA Y N NA <br /> TQnk-87N X Tank-91 X <br /> Tank-87S XI Tank-Additive Tank X <br /> 8 Under-dispenser Com.tnmem areas are frce of wafer,debris,and hazardous substance. Sensors are located properly <br /> V N NA V N NA <br /> Dispenser-112 IX I I I Dispenser-9/10 X <br /> Dispenser-3/4 _ _ X Dispenser-//.'12 <br /> X <br /> Di.cpenser3/6 7 f <br /> Dispenser-7-B 1C <br /> PAPERWORK INSPECTION Y N NA DATE DONE <br /> 9 Monitoring system certification has been completed within past 12 months. X 925/14 <br /> 10 Secondary containment tests have been complaed within the required timeframe. X sins <br /> 11 Spill containment structure(bucket)testing was completed within the past year, X 9125114 <br /> 12 Tank tighisam testing was complcccd within required timeframe. X N/A <br /> 13 line tightness testing was completed within required timeframe. X N/A <br /> 14 Other required testing/maintenanec was completed within required timeframe.(List test/maintenancc items below) <br /> Test/Afamtenance: X WA <br /> Tedb'Mamlenance: X N/A <br /> '1'esuMrriwenance: X WA <br /> FACILITY EMPLOYEE TRAINING Y N NA <br /> 15 All facility employees have received the required on-the-job training within the past year X <br /> 16 1 All facility employees hued within the past 30 days have received the required on-Ihe-job vainiag. X <br /> Note: Aoy answer of"N"should be explained is the comment section on the following page,and will require follow-up <br /> action. <br /> Page I oft <br />