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20`13-06-13 04:02 2600 2098302954 >> P 4/8 <br /> ez Designated Underground Storage Tank(UST) Operator <br /> ( ) Pe <br /> Monthly Visual Inspection Checklist <br /> Facility uame:gafewa FaCitity Address: 1804 West 11Th. Street Tracy. CA 95376- <br /> Person Canducting Inspection;Maria Guamelli Phone: 408) 971-2445 Date: <br /> u t'2 <br /> r <br /> 1r <br /> Signatu ,, ICC Cert: - - <br /> '� ;.- Exp Date: <br /> Instructions <br /> 1.Tho monthly UST system Inspection must be conducted by a Designated UST Operator who possesses a current"California UST System <br /> Operatol'exam issued by the IntemaWnal Code Council(ICC). <br /> 2.The Designated UST Operator must alert the UST Owner or Operator of any Condition discovemd during the M"Ily,visual inspection that <br /> may require folksw-up actions. <br /> 3.A copy of this monthly inspection report must be provided to the UST Owner or Operator. <br /> 4.The UST Owner or Operator must maintain a Copy of each monthly irMpeation report and all attachments for the most recent 12 months. <br /> The records shall be maintained on-site or,it approved by the local agency,oft-site at a readily available location. <br /> Nota Answer Items and system items with 'Y"fpr Yes, 'N"for No and NA for Not Applicable-Any answer of'N'should ba explajmd <br /> in fire comment swcban and w#1 rimWim correctiv9 action hum ft UST ownenbperator. <br /> ltL'ft) 1 llttj M1i i r. �1ltft DrY Y ! N J- .MA <br /> I Is the monitoring system powered on and In prooper operating mode? <br /> 2 Is the monitoring system not currently showing any leak alarms or warnings? <br /> 1 3 Is the Alarm History rePOWI09 tar the previous month available,and has it been reviewed by the Designated � <br /> UST Operator? (Attach a copy of the alarm history mporMg to this inspecft l form if available.) <br /> 4 Has each alarm for the previous month been responded to approprnatety? <br /> UST WIFISPecoon Y./. N / NA <br /> 5 Are tank-top containment sumps free of water,debris,and hazardous substance?Are sensors located properly? <br /> Note:tf the GO&W to C 4 was'Y',eklP to it s.Sumps where an arerm hes owwad m rhe past month mltst be inapecled d a <br /> I=nor responded to.and property adWesaed me Cause of the alam+ i)ocurrant0kw a qultaLt Service t VPW, n <br /> ►eritYm9 pp+opriaro sarvioa 5tarrtd be ertecned to this,gpo,t. <br /> Sump Location: Sump location: <br /> Sump LocaWn. Sump Location: <br /> Sump Location: Sump Location: <br /> 6 Are spill buckets(containment structures)tree of water,de",and hazardous substance? <br /> Tank 01 -Regu 7 Tank <br /> Tank 02-Prem Tank <br /> Tank 03-Diesel Tank <br /> 7 Are under-dispenser containment grew free of water,debug,and hazardous substance?Are sensors located property? <br /> Dispenser 01-02 Dispenser 09-10 <br /> Dispenear 03-04 Dispenser 11-12 <br /> Dispenser 05-OB Dispenser 13-14 <br /> Dispenser 07-08 D►Spenser 15-16 <br /> System in f .i . Ct <br /> 8Monitoring Cetfcation was Completed Within the past months? <br /> %4 <br /> 9 Line Least Detectors were tested/cedifled within the past 12 months? <br /> 10 Spill orintalnment Structure(buckets)testing completed within the past 12 months? <br /> 11 Secondary containment tests Completed within the required time home? N <br /> 12 Other required testing/maintenance was compietee within rewired time frame? (List test/Maintenence items below.) <br /> Describe Test/Mafntenance: 1-1rTC5 t_L <br /> Describe Test/Malntenance: <br /> FaCU "Trains <br /> YEm' oY Y / N / MAI <br /> 13 have all taidlity employees received the required on-the-fob training within the past year? <br /> 14 Have all fadlity employees hired within the past 30 days received the required o1-the-job training? <br />