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OCT-27-2008 13:23 CITY OF LODI 209 333 6710 P. 13 <br /> UNDERGROUND STORAGE TANK?YSTEM <br /> DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT <br /> .. Facility Name: City of Lodi Inspection Date: December 24,2007 <br /> Facility Address: 1331 S. Ham Lane City Lodi <br /> Name of Designated UST Operator Conducting Inspection: Dermis Callahan <br /> International Code Council Certification No.: 1004653-UC Expiration Date: 12/20/2008 <br /> Signature: Phone: (209) 333-6800 ext. 2690 <br /> N/A=Not A livable <br /> Item MONITORING PANEL/ALARM HISTORY Yes No N/A <br /> 1. is the monitoring em Mwered on and in r tin mode? <br /> TY 0 <br /> 2. Is the monitoring ein not current!y showing any leak alarms? <br /> 3. Is the Alarm History Repordlog for the previous month available,and has it been reviewed by the <br /> Desi ated UST or? Atkach a coffo the alarm hist re rta to this ins coon orrm <br /> 4. Has each alarm for the vious month been res onded to a ro riatel ? <br /> USI'SYSTEM INSPECTION <br /> 5. Are tank-top containment sumps five of water,debris,and hazardous subsiance2 xob:if d&answer to Item 4 was"Yes. sbp <br /> to Item 6 ,Gimps vi?cre an alarm has occurred rrt rile past month mus►be inspected if a qualified senvice reehnrcran lros owt rerp iFded to, and <br /> ETMrA oddremed an maw of the alone Doaarea+ration wrf .service sWxW be auocW to&b <br /> Yes No Yes No ,;I <br /> Sump Location: S/W Fuel Island Locations N/E Fuel Island <br /> Sump Location'N/W Fuel Island U I Location: SIE SW M I LJ <br /> 6. Ares ill buckets containment structures)free of water,debris,and hazardous substance? Yes No N/A <br /> Yes No N/A <br /> Tank 1 1D— 10,000 Unleaded 0 1 Ll 1 0 Tank 4 ID—Waste Oil <br /> .., Tank 2 ID— 4000 Unleaded 0 1 Ll I U Tank 5 ID— <br /> Tank 3 ID— 5,000 Diesel Tank 6 ID— <br /> T Are tinder-dispenser containment areas free of water,debris,and hazardous substance? Yes No N/A <br /> Yes No iN/A <br /> Dispenser—.112 Multi-product El I Q Dispenser— <br /> Dis <br /> is nser— <br /> Dis user— Dis ser <br /> Di Pensef— Dispenser— <br /> Dispenser— Dispenser— <br /> 8. Leak detection is o located within under diwnscr containment Yes No N/A <br /> Yea No N/A <br /> Dispenser-1/2 Multi- induct Dispenser— <br /> Dis user-- Dispenser— <br /> Dis ser— Dis ser - <br /> Dis <br /> Dispenser— Di asci— <br /> Yes No N/A.... Date on <br /> PAPERWORK INSPECTION e <br /> 9. monitoringSystem Certification vies completed within the 12 months. 7 <br /> 10, Line Leak Detectors were tested/certified within e l2 months? <br /> th9/27/2007 <br /> 11. Spill bucket containment structuretesting completed within the past 12 months? <br /> 12. Line tightness testing completed within the required tithe frame? 2/13/2007 <br /> 13. Second containment tests completed within the uired time frame? al i3 S' 10/`•5!2007 <br /> 14. Enhanced Leah Detection completed within the required time Game? [ <br /> 15. Other r wired testis maintenance was completed within r uired time frame? te.Wmcpntenance items below_) <br /> Describe Test/Maintenance:Dr Tube In Test- 3 s 10/312005 <br /> Describe TestlMaintenanoe Static Tor ue&Rotation Test-ev 3 10!31/2005 <br /> �, . <br /> FACILITY EMPLOYEE TRAINING Yes NoN/A <br /> 16. Have all facilq employees received the required on-the-job training within the past ? <br /> 17. Have all facility employees hired within the past 30 days received the required on-4be job training. <br /> Note: Explain any"No"answers in the"Comments"section on the following page.Those issues require corrective action from <br /> the UST owtier/operator. <br /> ww.v.e■idols org 9/=6/05 <br /> UN-057-1/2 <br />