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OCT-27-2009 18:21 CIT`' OF LODI 209 333 6710 P.05 <br /> UNDERGROUND STORAGE TANK SYSTEM <br /> DESIGNATED. UST OPERATOR MONTHLY INSPECTION REPORT <br /> Facility Name: City of Lodi Inspection Date: August 22, 2008 <br /> Facility Address: 1331 S. Ham Lane City: Lodi <br /> Name of Designated UST Operator Conducting Inspcction: Dennis Callahan <br /> International Code Council Certification No.: 1004653_UC Expuabon Date: 12/20/2008 <br /> Signature: Phone: (209) 333-5800 ext.2690 <br /> N/A-Not A ' bk <br /> Item MONITORING PANEL/ALARM HISTORY Yesl No I N/A <br /> 1. Is the monitori em Epwred on and in proper o tin mode? 191 El I CT_ <br /> 2. Is the monitoring system not currently showing any leak alarms? <br /> 3. Is the Alarm History Report/log for the previous month available, and has it been reviewed by the <br /> Desi ated UST or? Attach a copy o the alarm history repwWog to this ins coon arm. <br /> 4. Has each alarm for the previous month been responded to a r el ? A1C <br /> UST SYSTEM INSPECTION <br /> 5. Are tank-top containment sumps free of water,debris,and hazardous substance? Note:ifdw w wrr to Item 4 wn`yes, skip <br /> ro Ituro 6. Sumps where an alarm has occurred in rhe port momh mrlsr*mspecred rf a grtarifred service recharoun has nor responded lo, and <br /> properIr addressed/he eaum o rhe alArrrr Documoriatran vert a servke should be aijached to this report <br /> Yep No Yes No <br /> Sump Location: S/W Fuel Island Sunip Location_N/E Fuet Island <br /> Sum Location NNV Fuel]stand <br /> SEMp Location: SIE SLoe <br /> 6. Are spill buckets containment structures free of water,debris,and hazardous substance? <br /> Yes No N/AI Yes No N/A <br /> Tank I ID— 10,000 Unleaded j I Tank�IDWaste OilTank 2 ID-- 2,000 Unleaded Tank <br /> El El I LJ <br /> Tank 3 ID-- 5,000 Diesel 0101 L1 I Tank 6 TD— <br /> 7. Are under-di ser containment areas free of water,debris,and hazardous substance? <br /> Yes I No I N/A I Yes I No I N/A <br /> Dispenser—1/2 Multi-product Dispenser I C1 I Ll <br /> — <br /> Dispenser-- �H Dispenser Dispenser^ Dispenser— <br /> EF <br /> Dispenser— Di nser— <br /> 8. Leak detection is properly located within under-dispenser containment <br /> Yes No NIA Yes No N/A <br /> Dispenser— 1/2 Multi uct I El IDispenser— <br /> Dis enser— Ej I El I Lj I Dis nser— <br /> Dispenser— Dispenser— <br /> Dispenser— - <br /> PAPERWORK INSPECTION Yes No NIA Date Doae <br /> 9. Monitoring System Certification was completed within the past 12 months? M I Lj El 9/27/2007 <br /> 10. Line Leak Detectors were tested/certified within the past 12 months? 9/27/2007 <br /> 11. Spill bucket containment gtructuro testing completed within the past 12 months? El 9/27/2007 <br /> 12. Line tightness testis completed leted within the required time Esme? 2/13/2007 <br /> 13. Secondary containment tests oom leted within the required time frame? 0 e 10/5/20071 lege <br /> 14. Enhanced Leak Detection completed within the required time frame? tl v5 <br /> 15. Other required testis maintenance was completed within requirod time frame? t test/mm-Wenance items below. <br /> Describe Test/Maintenance: Dr Tube In Taut-every3 1013112005 <br /> Describe Test/Maintenance: Static Torque& Rotation Test-every 3 yrs LN I LJ I 1(/31/2005.11 <br /> FACILITY EMPLOYEE TRAINING Yes No N/A <br /> 16. J Nave all 11kcility employees received the required on-thtjb training within the p2A year? 0 IT <br /> 17_ 1 Have all Facility employers hired within the past 30 da s received the required onA2e b training.? EA <br /> Note: Explain any"No"answers in the"Comments"section on the following page,Those issues require corrective action from <br /> the UST owner/operator. <br /> UN-057-1/2 www.adidoes.org 9!26/05 <br />