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2013-06-13 04:04 2600 2098302954 >> P 6/8 Designated Underground Storage Tank (UST) Operator Monthly Visual inspection Checklist Facility Name-Safeway Facility Address: 1804 West 11 Th. Street Tracy, CA 95376- Person Conducting inspection:Maria Guarrielii Phone: 408 971-2445 Date: 44 Signatu ICC C Cert: Exp pate. Instructions 1.The monthly UST system inspection must be opnducted by a Designated UST Operator who possesses a current"California UST System Operator'exam issued by the International Code Council(ICC). 2 The Designated UST Operator must alert the UST towner or Operator of any Condition disCOvered during the monthly visual inspection that may require follow-up actions 1 A copy of this monthly inspection report must be provided to the UST Owner or Operator. 4,The UST Owner or Operator must maintain a Copy of eaCh MOnthly Inspection report and all attachments for the most recent 12 months_ The records shall be maintained onsite or,if approved by the local agency,Off-site at a readily available location. Note./inswer items and system items with'Y"Ibr Yes, "N"/or No and NA for Not Applicable.Any answer of"N"should be explained in the comment section and wdl raquim 00"ctive eCtiort tram the UST owner/operator. I.kerrj Monitoring Panel/Alarm History Y / N / NA 1 Is the monitoring system powered on and In proper opembrig mode? y 2 Is the monitoring system not currently showing any leak alarms or warnings? y 3 Is the Alarm History report/log for the previous month available,and has it been reviewed by the Designated UST Operator (Aftach a copy of the a/arm history rsportRog to this inspection form 11 available.) Y 4 Has each alarm for the previous month been responded to appropriately? UStf 5 action Y / N / NA 5 Are tank-top containment sumps free of water,debris,and hazardous substance?Are sensors located property? Note--It the answer to 0 a was'Y'skip to C 6, Sumps where an alarm has occured in the past monm must be, inspected d a qualified soft ca lechmc+an has not responded to,and Property adOrV med the cause of the atarm-DocunlCrdation vemwag appropriare service should be affached to this repos. Sump Locatlon_ Sump Location: Sump Location: Sump Location: Sump Locabon: Sump Location: 6 Are SPIN buckets(Containment structures)free of water,debris,and hazardous substance? Tank 01 -Regu Tank Tank 02-Prem Tank Tank 03-Diesel Tank 7 Are under-0ispensgr containment areas free of water,debris,and hazardous substance?Are sensors located property? Dispenser 0102 Dispenser 09-10 Y Dispenser 03-04 y Dispenser 11-12 Dispenser 05-06 Y Dispenser 13-14 V Dispenser 07-08 Dispenser 15.16 Y, g System Certification was completed within the . • ,., f�ip}ectltfet�! [�Ipisrtion 8 Monitoring t]att;Diyne p past 12 months? 4 Line Leak Detectors were tested./certified within the past 12 months? y 10 Spill containment structure(buckets)testing completed within the past 12 months? r 11 Secondary containment tests completed within the required time frame? r 12 Other required testing/maintenence was Completed within required time frame? (list tast/Maintenanoe items ibek)w_) Describe Test/Maintenance: y ��t Describe Test/Maintenance: ._ I� Y 1 M:1 NA F�dci'� E .�.h,IA ; .e Tr8lirtiin a3H.vme all facility employees received the required on-the-job training within the past year? ave all facility employees hired within the past 30 days received the required on-the-job training?