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20'13-06-13 04:03 2600 2098302954 >> p 5/8 <br /> Designated Underground Storage Tank (UST) Operator <br /> Monthly Visual Inspection Checklist <br /> rFN, -Safewa Facility Address: 1804 WeSt 11Th. Street Tracy, CA 95376- <br /> Personucx ihepect�rt:Niat�a Guarrtelt; Phone- 40$)971-2445 Date <br /> 6Ao( <br /> Uw L ICC Cert:cExp nate: ,InstrgCtiotrs. .thly UST system inspection must be conducted by a Designated UST Operatarwho possesses a current"califomia UST Syslemxam issued by the international Code council(ICG). <br /> 2.The Designated UST Operator must asert the UST Owner or Operator of any condition dLgc&*red during the monthty visual inspection that <br /> may require follow-uo actions. <br /> 3.A copy of thio monthly Inspection report must be provided to the UST Owner or Operator, <br /> a.The UST Owner or operator must maintain a Dopy of each monthly inspection report and all attachments for the most recent 12 months. <br /> The records shalt bre maintained ort-site or,it approved by the local agency,off-Site at a readily available location. <br /> Noce:Answer items and system Items with-Y"for Yes, N`for No and NA for Not AAt)jk8ble.Any answer of 7V'should be explained <br /> In the CArnntertl sKIiian and wit newts correaive action hp,m the UST ow mat)pgrafor. <br /> a nlitdtin$Penei 1 Mann <br /> NistotfY., Y / N f. NA <br /> 1 is the monitoring sytatem pe mored on and in proper operating mode? v <br /> 2 Is the monitoring system not c wrentty showing any leak alarms or warnings? <br /> 3 Is the Alarm History report/tog for the previous month available,and has it been reviewed by the Designated <br /> UST Operator? (AltBch a copy of 1179 alarm history raporWog to this inspection form if available,f Y <br /> 4 Has each alarm for the previous month been responded to appropriately? <br /> UST om the ecoon Y 1 N 1 NA <br /> 5 Are tank-top containment sumps free of water,debris.and hazardous substance?Are sensors located properly? <br /> Note IF 1110 UFWKW to a 4 wtr5'Y"skip m e 6 Saanpa where hn aramr rias QWU70d m the pilaf month must be klVeVild A a Qualified servroe tetnnipan <br /> has trot mdPwraled fi.sod p+DWY addressed the rause of the alarm Documentahm veriyirg apProprate sWWO-V shoat be attached 10 thm report. <br /> Sump Location: Sump LocWlon- <br /> Sump Location: Sump Location, <br /> SUMP Locattom Sump Location- <br /> 6 Are spill bw*ets(containment stnlctufes)free of Water,debris,,and hazardous substance? <br /> Tank 01 -Regu til Tank _ <br /> Tank 02-Prem Tank <br /> Tank 03-Diesel Tank <br /> 7 Are under-dispenser contalnment areas tree of Walter.debris.and hazardous substance?Are sensors located properly? <br /> Dispenser 01-07 Dispenser 09-10 � <br /> Dispenser 03-04 f Dispenser 11-12 <br /> Dispenser 05-06 Y Dispenser 13-14 <br /> Dispenser 07-08 `� DL oWmr 15-16 <br /> PapetWO C insp>a tion. Y l u 1:1iA':, :t?st�t Bone <br /> 9 Monitoring System Certifrrabpn was completed within the past 12 months? 1� <br /> 9 Lana Leak Detectors were testedteertitled within the past 12 months? y ,.�•L <br /> 10 Spill containment stricture(buckets)beating completed within the past 12 months? !,. <br /> P12Mer <br /> Secondary containment tests completed within the required time frame? <br /> required tashVmaintenanm was completed within required time frame? (1_ist toaWaintenance items b9low.) <br /> Describe TestlMaintenanee: >-A 1 •1 q.- <br /> Describe Teet/Maintenance: <br /> Fltclllty:Emplay$e.Ttahft Y.l N'1 NA' <br /> 13 Have all faodky amplpyees MWVed the required on-theiob training within the past year? <br /> 14 Have all fadllty employees hirW within the past 30 days received the required on-the-)ob training <br />