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Designated Underground Storage Tank (UST) Operator Monthly Visual Inspection Checklist Facility Name: Food Mart Gasoline I Date: `<-y Ck - Facility Address: 2185 Fremont Street 1 City: Stockton, CA. Zip Code: 95205 Designated UST Operator Conducting the Inspection: Mark R. Fairbanks, Fairbanks Environmental Consulting FEC International Code Council ertification # 5243795 -UC Expiration Date: September 2010 -Signature: 614.(& ice' Phone: 209 993-3298 Cell, 209 754-1636 Office ' ` Y =Yes, N= No, NA = Not A licable Item I MONITORING PANEL / ALARM HISTORY I Y I N I NA 15 All facilityemployees have received the required on-the-job trainingwithin the past year. .k'I j 16 1 All facility employees hired within the 2ast 30 days have received the required on-the-job trainin . Note: Any answer of "N" should be explained in the comment section on the following page, and will require follow-up action. Pagel of 2 November 2004 1 Monitoring system is powered on and in proper operating mode. 2 Monitoring system is not currently showing any alarms or warnings. 3 Alarm history report/log for the previous month is available, and has been reviewed by the Desi nated UST Operator. Attach a copy of the alarm history report'log to thisform if available. 4 Each alarm for the previous month has been responded to appropriately. 5 Sensors located in tank -top containment sumps have not alarmed in the past month. 5a _ List all tank -top sumps where alarms occurred in the past month: Note: Sumps where an alarm has occurred in the past month must be inspected unless a qualified service technician responded to, and properly addressed, the cause of the alarm. Attach documentation verging appropriate service to this report. Isump inspection is required, record results in item 6, below. UST SYSTEM INSPECTION 6 Tank -top containment sumps are free of water, debris, and hazardous substance. Sensors are located properly. Note: {visual inspection o sum s is only required in sums where an alarm has occurred in the past month or which there is no service record. Y N Y N Sump Location: ` e e) L. Sump Location: Sump Location: , " //'L't- Sump Location: Sump Location: - < Sump Location: 7 Spill containment structures are free of water, debris, and hazardous substance. Y N NAY N NA Tank 1 - Contents: Tank 3 - Contents: Tank 2 -Contents: _c.> LL Tank 4 - Contents: 8 Under -dispenser contain .ent areas are free of water, debris, and hazardous substance. Sensors are located properl . Y I. N I NA Y I N INA Dispenser 1 / 2 Dispenser 9.110 Dispenser 3/4 Di enser 11 �` 12 Dispenser 5 1'6 Dispenser 13 ','14 Dispenser 7.18 Di. enser 15.116 PAPERWORK INSPECTION Y . N NA DATE DONE 9 Monitoring system certification has been completed within past 12 months. - o ; 10 Secondary containment tests have been completed within the required timeframe. r `91 _611 11 Spill containment structure bucket testing was completed within the past year. 12 Tank tightness testing was completed within required timeframe. I I - - d 13 Line ti htness testing was completed within required timeframe. 14 Other required testing/maintenance was completed within required timeframe. (List test/maintenance items below. TestuMaintenance: Test/Maintenance: Test Maintenance: FACILITY EMPLOYEE TRAINING Y I N I NA 15 All facilityemployees have received the required on-the-job trainingwithin the past year. .k'I j 16 1 All facility employees hired within the 2ast 30 days have received the required on-the-job trainin . Note: Any answer of "N" should be explained in the comment section on the following page, and will require follow-up action. Pagel of 2 November 2004