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Designated Underground Storage Tank(UST) Operator <br /> Monthly Visual Inspection Checklist <br /> Facility Name: COSTCO 0658 Date: 5/20!2015 <br /> Facility Address: 3250 w.Grsuume Rd <br /> City:Tr■cy Zip Code: 95377 <br /> Designated UST operator Conducting the Inspection: Gabriel Martie <br /> International Code Council Certification H: 8260320 Expiration Dace: 6/5!2016 <br /> Phone: (949)460-5200 <br /> $lgnatUre: \ _}'es, C-4-114 ot Applkat le <br /> Item MONITORING PANEL/ALARM HISTORY Y N NA <br /> �.9 <br /> B Y P pr pe oP� B X <br /> 1 Mottitorin S stem is powered an and in o r tin mode <br /> 2 Monitoring system is not currently showing any alarmsX or warnings. _ <br /> 3 Alarm history report/log for the previous month is available,and has been reviewed by the Desigmued UST X <br /> operator. (Attach a copy of the alarm history reporUlog 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 alarmed in the past month. X <br /> Sa - Liu all lank-top sumps where alums occurred in the past month. <br /> Note:Sumps uhre an alarm has occurred m the past month ,at be larpecud lidless a qual*dwrvlce wohmemn responded to.asd properly <br /> addneued.the cause of the alarm..}ruuh documenralfm wrtfyrllg ap WFiate Nervily to this"¢part.(f.rvmP InrpeCaan es rcqulred record remlu <br /> at 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 /> Abl" Woo/ua1Mr'M1m of++earn n n^!v rryu,red in r�Kat whrrt M aAvm ha oavrtdln Ile ywt+rtarN lar wh>h+hrn 1>na>erv/ce rt�aN <br /> Y N ;;.. Y N <br /> Sump Lacanian: <br /> WA Sump Location: MA <br /> WA Sum Location: " <br /> Sump Location: P <br /> Sump Location: Sump Lmation: <br /> _ <br /> 7 Spill containment structim s are free of water,debris,and hazardous substance. <br /> Y N NA Y N NA <br /> Tank-87:V X I I I Taak-9/ X <br /> Tank-87S X I I I Tana,,twtnlve Tank X <br /> 8 Undervdispenser containment areas are free ofwater,debris,and hammous substance. Sensors are located properly. <br /> Y N NA Y N NA <br /> Dispenser-1/2 X Dispenser-9110 X <br /> Dispenser-3/4 X Dispenser-11,42 X <br /> Dispenser-3/6 X <br /> Dispenser-7i8 X <br /> PAPERWORK INSPECTION Y N NA I DATE DONE <br /> X <br /> 9 Monitoring system certification has been completed within past 12 months. WM147/4115 <br /> 10 Secondary containment tests have been completed within the required timeframe. X <br /> 9/)5114 <br /> I I Spill containment structure(bucket)testing was completed within the past year. X X �tA <br /> 12 Tank tightness testing was completed within required timeframe. X NIA <br /> 13 Line tightness testing was completed within required timeframe. <br /> 14 j other required testily maintenance was complexed within required timeframe.(List test/maintentmee items below) <br /> low) NIA <br /> I TesbMainnenance. <br /> Test/Maintenance: <br /> ---- X NIA <br /> TesUMainlenance: <br /> FACILITY EMPLOYEE TRAINING Y N NA <br /> 1 15 All facility employees have received the required on-Ihe-job training within she past year. X <br /> 16 All facility employees hired within the p!Lu130 days have received the required on-mh job training. X <br /> Note: Any answer of"N^should be explained in the comment section on the following page,and will require fellow-ap <br /> action. <br /> Page I of 2 <br />