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OCT-27-2008 18:22 CIT`.' OF LODI 209 333 5710 P.07 <br /> UNDERGROUND STORAGE TANK SYSTEM <br /> DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT <br /> Facility Name: City of Lodi inspection Date: ,lune 20, 2008 <br /> Facility Address: 1331 S. Ham Lane City: Lodi <br /> Name of Designated UST Operator Conducting Inspection: Dennis Callahan <br /> International Code Council Certification No.: 1004653-UC Exptratlan Date. 12/20/2008 <br /> Signature. Phone: (209)333-6800 ext.2690 <br /> N!A <br /> —Not A lkabk <br /> Item I MONITORING PANEL/ALARM HISTORY YcsI No I N/A <br /> 1. Is the monitoring s stem veered on and in mode? 0 L11 Li <br /> 2. Is the monitoring stem 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 /> Designated UST Operator? attach a copy of the alarm hW22 report/INporqog to this inTecfionform.) <br /> 4. Has each alarm for the previot.ts month been EegLonded to a ro riatel . ILJ <br /> UST SYSTEM INSPECTION <br /> 5. Are tank-top containment sumps free of wafer,debris,and hazardous substance? Note:Ijdte answer to Item.t w= "Yes,"slap <br /> ro Item h Sumps irlier•e at alarm has occurred in rlrc pa-rr month mite he mspeetad h a tpralitried xroce technician has not responded to, and <br /> properproperop addre&wk die coat¢ofdo atom Docamextatlon wqfyhw mwwce shostH he adwJmd to dds repork <br /> Yes N0 Yes No <br /> Stoup Location: S/W Fuel Island S Location_ N/E Fuel Island <br /> Sump Location:N/W Fuel Island EF S Logtion: S/E$ <br /> 6. Are spill buckets containment structures)free of water,debris,and hazardous subsfarlce? <br /> Yes No N/A Yes No N/A <br /> Tank 1 ID— 10,000 Unleaded Tank 4 ID—Waste Oil <br /> ^• Tank 2 TD— 2,000 Unleaded Z I Lj.I U I Tank 5 ID— <br /> Tank 3 ID— 5,000 Diesel Tank 6 ID— <br /> 7. Are under-dispenser containment areas free of water,debris, and hazardous substance? <br /> Yes No N/A I Yes No N/A <br /> Dispenser— 12 Multi-product M 1 i user— <br /> Di enser - r, Dispenser— <br /> TH <br /> Dispenser— Di ser - <br /> El <br /> Di user— D' ser— <br /> El I <br /> 8. Teak detection is E2Mly located within under-dispenser containment- <br /> Yes I No I N/A Yes No I N/A <br /> Dispenser— 1/2 Multi-product Dispenser— El <br /> 11 <br /> Dispenser— D — <br /> Dispenser— Dis ser— <br /> ED 11 <br /> Dispenser— LJ I El I .LJ Dis ser— <br /> 9. Mon Certification w s . <br /> PAPER O RK INSPECTION Yes No N/A Date Done <br /> Monitoring Sys" was completed within the post 12 months? 1 9/2712007 <br /> 10. Line Leak Defectors were tested/certified within the past 12 months? 827/21107 <br /> 11. Sill bucket containment structure testingcompleted within the 12 months? 9/27/2007 <br /> 12. Line ti tress testing com feted within the required time frame? 2/13M007 <br /> 13. Secondary containment tests completed within the required time frame? 10/5/2007- tie s� <br /> 14. Enhanced Leak Detection completed within the required time&ame? I t {� 019,3,_ <br /> 15. Other required testinemaintenance was completed within required time fraune? List test maintenance items below.) <br /> Describe Test/Maintenence:Drop Tube Integrity Test-every 3 10/31/2005 <br /> Describe Test/Maintenance: Static Torque&Rotation Test-every 3 yrs I N I Ll I Ll 1 10./31/2005 <br /> FACILITY EMPLOYEE TRAINING Yes No N/A <br /> 16. 1 Haveall facilityemployees received the required on-the b trainingwithin the ear=l <br /> - 17. Have all Facility employees hind within the 30 days received the required on-the= b training.? <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 /> VN-057-1/2 www.nuidomorg 9126/05 <br />