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4315 E Waterloo Rd <br />04/18/18 <br />Designated operator monthly inspection report dated 11/16/17. <br />Inspect u,n Date: ------ <br />12/4/2017 <br />t <br />PR0231760 <br />PHOTO # <br />UNDERGROUND STORAGE TANK SYSTEM <br />DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT <br />Facility Name: t_ <br />Waterlocl Shell Inspection Date: 11116/2017 <br />Facility Address: 4315 E. Waterloo Rd4ty: <br />C Stockton <br />Name of Designated UST Operator Conducting Inspection: Alex Jabbari <br />International Code CO LIFICil (lertification No.: 5243897 -UC <br />Signature: <br />C. <br />Expiration Date: 141312018 <br />Phone: 925'; 389-1262 <br />NIA ='riot A pplicabit <br />[tem MONITORING PANEL /ALARM HISTORY Yes' No N/A <br />1. Is the monitoring system powered on and in proper operating mode? <br />2. Is the monitorings stem not currently showing any leak alarms? <br />3. 1s the Alarm History Report/log for the previous month available, and has it been reviewed by the <br />Designated UST Operator? (,4ttach a copy ( 'the alarm history re ort/la to this inspection orm.) <br />4. Has each alarm for the previous month been responded to appropriatel), ? <br />UST SYSTEM INSPECTION <br />as <br />5. Are tank -top containment sumps free of water, debris, amohazardous <br />mau t he inspected <br />f a call fed if <br />rvi a to hnician has not responded <br />"NA" skip to !tent 6. Sumps where an alarm has occurred in the pas <br />to and ra r addressed, the cause o the alarm. Documentation vert in a ry nate sen'tcd should he attached to this re rt. <br />No <br />Yes No ---- <br />Sump Location: <br />sunt Location: Sump Location: <br />Sump Location: <br />Yes, No NIA <br />Are ill buckets containment structures free of water, debris, and hazardous substance. ' <br />6 Yes No N/A <br />Tank 3 ID - <br />LN <br />Tank 1 ID — Re lar <br />Tank 4 I D - <br />ank 2 ID —Premium and hazardous substance? vt, ;NIA <br />_ _ �.� „t".unter_ debris, Yep Y , <br />Aaron Hang, EHS Page 25 of 36 <br />