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Designated Underground Storage Tank (UST) Operator F G F <br /> Monthly Visual Inspection Checklist <br /> Facility Name:Bo ett Valero(REVISED FOR TYPO) Date: 12/29/14 <br /> —Facility Address: 1137 W Lathrop Rd <br /> City:Manteca Zip Code: 95337 EFEN VAROWAFL <br /> Designated UST Operator Conducting the Inspection:Karen R Arnaiz OF T T <br /> International Code Council Certification#: 5266643-UC Expiration Date: 05/31/15 <br /> Signature: Phone:(209) 518-4836 <br /> Y=Yes,N=No,NA=Not Applicable <br /> Item MONITORING PANEL/ALARM HISTORY Y N NA <br /> I Monitorings stem is powered on and in proper operating mode. X <br /> 2 Monitoring system is not currently showing any alarms or warnings. X <br /> 3 Alarm history report/log for the previous month is available,and has been reviewed by the X <br /> Design ed UST Operator. (Attach a copy o the alarm history report/log report/logto this form if available.) <br /> 4 Each alarm for the previous month has been responded to appropriately. X <br /> 5 Sensors located in tank-top containment sumps have not alarmed in the past month. X <br /> 5a _ List all tank-top sumps where alarms occurred in the past month <br /> Note:Sumps where an alarm has occurred in the past month must be inspected unless a qualified service technician responded to,and <br /> properly addressed,the cause of the alarm.Attach documentation verging appropriate service to this report. <br /> If sump inspection is required,record results in item 6,below. <br /> UST SYSTEM INSPECTION <br /> 6 Tank-top containment sumps are free of water,debris,and hazardous substance. Sensors are located properly. <br /> Note: visual inspection of sumps is only re uired in sumps where an alarm has occurred in the post month or which there is no service record.. <br /> Y N FWW1 Y N <br /> Sump Location:87 STP combo X Sump Location:diesel STP combo X <br /> Sump Location:87 ill piping X Sump Location: diesel fillpiping X <br /> Sump Location:91 STP combo X Sump Location:fill box combo piping X <br /> Sump Location:91 fill piping X <br /> 7 Spill containment structures are free of water,debris,and hazardous substance. <br /> Y N NA Y N NA <br /> Tank 1—Contents: 87 X Tank 3—Contents:Diesel X <br /> Tank 2—Contents:91 X <br /> 8 Under-dispenser containment areas are free of water,debris,and hazardous substance. Sensors are located properl . <br /> Y N NA Y N NA <br /> Dispenser 1/2 X Dispenser 9/10 X <br /> Dispenser 3/4 X Dispenser 11/12 X <br /> Dispenser 5/6 X <br /> Dis enser 7/8 X <br /> PAPERWORK INSPECTION Y N NA DATE DONE <br /> 9 Monitorings stem certification has been completed within past 12 months. X 08/28/14 <br /> 10 Secondary containment tests have been completed within the required timeframe. X <br /> 11 Spill containment structure(bucket)testing was completed within the past year. X 08/28/14 <br /> 12 Tank tightness testing was completed within required timeframe. <br /> 13 Line tightness testing was completed within required timeframe. <br /> 14 Other required testing/maintenance was completed within required timeframe. (List test/maintenance items below. <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> FACILITY EMPLOYEE TRAINING Y N NA <br /> 15 All facili employees have received the required on-the-job trainingwithin the past year. 06/27/14 X <br /> 16 All facility employees hired within the past 30 days have received the required on-the-job training. X <br /> Note: Any answer of"N"should be explained in the comment section on the following page,and will require <br /> follow-up action. <br /> Page 1 of 2 November 2004 <br />