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2013-06-13 04:04 2600 2098302954 >> p 7/8 <br /> Designated Underground Storage Tank(UST)Operator <br /> Monthly Visual Inspection Checklist <br /> Fadlity Nemb:$a(gW8y. Fadkty Atitiresa; 1$44 WASt 11Th.Stress Tra ,CA 95376- <br /> P202 W'�'''$Imp :Marfa Guameili Ahone' 408 971-2445 <br /> aate:8/8/12 <br /> Signature. <br /> ICC Cert:8158671 Exp Date:5/11/14 <br /> Instructions <br /> 1_The monthly UST system kMPOcWn MUM be corrdtx ted by a <br /> OperNrlor'exam issued by the Irriemational Code Desigdated UST Operator who Possesaea a�OM'CallfOmia UST System <br /> 2.The(lest r,. ed UST {ICC)_ <br /> may require bllow.up actions. Or moat eters the UST(�"W kx Opergtor Of any COndition discovered during the n)ond*visual ftpoct*n that <br /> 3.A Copy of lhl9 monthly Inspection report motet be ptovl*d t0 the UST Owner of Operator <br /> 4.The UST Owner or Operator moat maintain a copy of each monthly 1116PBOW MPott and esti tttb;r Rents for the mO9t resent 12 montere. <br /> The recalls strati be maintained on-Me or,If aPPrpved by the lOCW agency,off-atte at a readily,avallabie kxCtion. <br /> Note 2answ®,mems aro system aeras with-y-for Yes W-for No and ACA for AV APOWb a.Any anter of W sftoutd be exprerr,ea <br /> rn!ire rmlmenf SOC600 and wNrequire CorrecMoe,aCNar f dw UST owned <br /> Item P 0, <br /> I�foMtoling Panni/Alarm plato <br /> 1 loft monitOru 19 system POWer®d on and In proper Operathtg model Y / N / NA <br /> 2 IS the ngtlEborhtg system not amenlFy eJtowirg any bsk atlrms or warns ? Y <br /> 3 Is the Mann history_p_VlOg for the prevWs month available,and hes d been rowewed the Y• <br /> UST operator?(Attach a ropy of the alarm history reporNtOg to tats inspection norm lraveflabie.) na� Y <br /> 4 Has Rech alarm fix the pious month been responded to ePp*opriatelyt Y <br /> LISTS en ! N t NA <br /> 5 Aro tank-top oontapinbnt Wnpb"a Of grater,debris,and ha78rdous subsbg ca?Aro aeneorg <br /> �bte:B Me answer to a<was"Y",slvp tv*6.Sum �Properly? Y <br /> ps whwe an alarm hes ocaned h the Past rnorrtb mud be <br /> ft4NZia <br /> not rBspenatsd to,and pv maty adeir wood Om cause of the ak mr.DoupllorAelbrt re eyed a 4 7Ped trdrnkfen <br /> Sump Location: rdY�D gvproprmre ser►rrob�Kruki be sgad,ad to Urls rYgyovt <br /> Sump Location: <br /> Sump Location: <br /> Sump LO f_ SUMP Location: <br /> Sump t.Ocsdton: <br /> 6 Arg spill buckets(confatnntertl Structures)fM of water, <br /> debris,anQ hazardous substance?Tank 01-Rego Y Tank <br /> Tank o2-Prem Y Tank <br /> Tank 03-Dk" Y Tank <br /> 7 Are uContainment areas fn%g of water,debrH,end <br /> Dispenser 0i-02 tarbsfar10e7 Ara m prop"? <br /> Dispenser 03-04 Y Dispenser 09-10 Y <br /> Dispenser 05-08 as wwr 11-12 N <br /> Dlepe+taer Y Dispenser 13-14 Y <br /> Y Dispenser 16-16Y <br /> PaPSrwO Ins On Y f N 1 NA <br /> t3 MmOca tg System Cart Gahm Was COmplatOC within Aye PMA 12 mo(Tft? - Bate Done. <br /> 9 Line leak Detectors Were tesied/certMod Within Mepast 12 mOlttha? - Y B'712— <br /> 10 SOU containment sbuc uJM(buckets)testing completed within the past 12 monft? Y 612 <br /> 11 Sdca,dary oorttalraneni testa—.a—Gded within tits ragrJrgd firne frame? Y 660/12 <br /> Y 11/16/1') <br /> 12 Other►squired teanrghnaintem nce was completed wQhin t <br /> wquired none Creme? (fist oeatlAdarntenencs items t>abw.) <br /> Describe TestANahttenance:Air Quality <br /> EHave <br /> escribe TeWMainim-nee: Y 4126/12 <br /> Facility <br /> sty Employee Training Y / N / NA <br /> Have all IaaT4 a1lptoy8es received tttg required prl ttte jpp <br /> baksog within the past year? Y <br /> all taaldy employe0s hired within ttre peat 3p d rgCetveG the <br /> requlred on-the-fob h-aimrQ? <br />