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2013-06-13 04:02 2600 2098302954 >> P 3/8 <br /> Designated Underground Storage Tank (UST) Operator <br /> Monthly Visual Inspection Ghecklist <br /> Facility NameSafeway Facility Address: 1804 West 11Th. Street Tracy. CA 95376- <br /> Perwn Coadticdrtg In9pwIon:Marla Guamelii Phone:(408) 971-2445 oate, <br /> signature <br /> !GC Cert: r xp EData: .11'r 1 L-4h <br /> 1.The monthly UST system inspection must be conducted by a Designated UST Operator who possesses a current"CaMomis UST System <br /> Operator"exam issued by the International Code Council(ICC). <br /> 2.The Designated UST Operator must atert the UST Owner or Operator of any condition discovered durtrtp the monthly visual inspection that <br /> may require foNaw-up actions, <br /> 3.A copy M IhW mgnthty fnspedion report must tie provided to the UST Owner or Operator. <br /> d.The UST Owner or Operator must maintain a copy of each monthly inspectlon report and all attachments for the most recent 12 months. <br /> The records shall be maintained on-site or,if approved by the local agency.off-site at a readily available location. <br /> Note.Answer items and system items with r for Yes, 'N'for No aril NA for WAWicable,Any answer of'N'should be explmned <br /> in the c orriniant section and wiN require corrective action hon the UST ow wWopemtor <br /> lttrrxi morlfto.` l J� dem, #oty Y 1 R4 ri t o <br /> 1 Is the rrwnitoring system powered on and In proper operating mode? <br /> 2 Is the morifting system not currentty aihowing any leak alarms or warnings? y <br /> 3 Is the Alarm History reporMog for the previous month available.and has it been reviewed by the Designated <br /> UST Operator? (Affacti a copy of the alarm history repor0og to this inspection tom If available.) <br /> 4 Has each alarm for the previous month been responded to appropriately? <br /> l! ir>rt; Y f N-t NA <br /> 5 Are tank-lop Containment sumps free of water,debris.and hazardous substance?Are Sensors located properly? <br /> Note..If fire acwwer to rr a Wn"Y`,skip to#6. Sumps WtMV an Warn fres O=Md m Me W month must be+rarperxed it a qua0ed service technicoff <br /> has rot reepOrKfed to,and propery addressed the cause of the al$ir»,fJUCtrr VotabM vexHying apprbprtate Service should be atrachoo fa this(epart. <br /> Sump Location_ Sump Location: <br /> Sump Locatlon_ Sump Location: <br /> Sump Locabort: Sump Location: <br /> 6 Are spill buckets(contalrownt structures)free of water,debris.and haxai sous substance? <br /> Tank 01-Regu Tank <br /> Tank 02-Prem Tank <br /> Tank 03•Diesel Tank <br /> 7 Are under-dispenser contalmnent areas he of waW,debris,and hazarrious substance?Are sensory Iocated property? <br /> Dispen:set 01-02 D'rspenwi 09-10 <br /> Dlspenw 03-04 y l7lsparraar 11-12 <br /> Dispenser 05430 `>t Dgmria,er 13-14 <br /> Dispenser 07-08 `/ Dispenser 15-16 '1f <br /> a Monitoring System Cendicatlon was c ntpleted within the past 12 months? <br /> 9 Line Leak Detectors were tegtadicentfled within the past 12 months? 1 <br /> 10 Spilt containment sOwWre(buckets)testing completed within ft past 12 months? , <br /> 11 Secondary contairinnent tests completed within the required time frame? ti t <br /> 12 Other required testingimamtenance was completed within required time frame? (List test/Maintenance items Wow.) <br /> Describe TestiMaintenanee7 U'--15 i <br /> Describe Test/Wintenance, <br /> �$C� y�? h15T3'>�i11lg •; r(^Y , .:f' NA <br /> 13 Have all facility employees received the required ort-ttre-lob training within the past year? <br /> 14Have au facility employees hired within the past 30 days received the required on-the•lob training? <br />