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cfl <br /> C) <br /> (V <br /> UNDEVRCROUND STORA T_ <br /> VATED UST OPERATOR MONT <br /> LY SYSTEM 00 <br /> INSPECTION REPORT c <br /> Marigold ShellO <br /> inspection Date: <br /> 6131 Pacific Avenue C:City: �f' ` �'/S N <br /> ,Califor, a 95207 <br /> StocktonY <br /> ted UST Operator Conduch _. Ins ection <br /> p Kathy Kotulak - ICU <br /> - <br /> Vde o cil Certification No_ 0 <br /> 5240722-UC Expiration Date: 7/29/2016 <br /> !c% Phone: (925)413-7422 ext. +' <br /> Z C <br /> M0i\I"i't)RIM1L PANEL!ALARM HISTORY N!A=Not:1 ricabtc — <br /> titorinQ sys•�em po crud on llld in rVP er u eratm�mode? Yes No N/A <br /> Y utortn system not currently showin�an leak alarms? <br /> 01 11 10 <br /> U m History Report�lo�for the previous month available,and has it been reviewed by the ❑M' <br /> � <br /> O d UST Operator? (Attach a copy o0he alarm histotit-epot t/log to tlrr.c in.c�ec riotr�nrnz) <br /> Harm for the previous month been responded to approriatew., <br /> co UST SYSTEM INSPECTION EO <br /> LLT El :)p containment sumps free or water,debris,and hazardous substance? Awe lfthe ans,ver m ltem a was Yes."skin V <br /> mps where an alarm has occurred tit Nye past month nmst be inspected if a qualified service techntcian has not responded to,and <br /> 'essed,the cause o/dre alarm.Documentation ro vertf3•tnq a.; grate service should be attached to this report. <br /> L <br /> W ttion: Ycs No Yes No <br /> ❑ 10 Sum Location: ❑ ` <br /> lion: ❑ ❑ Sump Location: I U I Lim N <br /> Q ickets(containment structures)free of water,debris,and hazardous substance? <br /> (� Yes No N/A Yes No NO, I 4- <br /> FL <br /> Regular 87 ❑ Tank 4 ID- ❑ ❑ [_, <br /> Premium 91 ❑ ❑ Tank 5 ID- ❑ ❑ ❑ <br /> QDiesel t?2 ❑ ❑ Tank 6 ID- ❑ ❑ U <br /> is enser containment areas free of water,debris,and hazardous substance? <br /> a Yes No N/A Yes No N/A v <br /> lit ❑ ❑ Dispenser- ®00 <br /> N <br /> 3/4 ❑ ❑ Dispenser- �- N <br /> t9 5/6 ❑ Dispenser- ❑ ❑ _ } <br /> 7/8 ❑ ❑ Dispenser- ❑ ® _ O <br /> In is properly located within under-dispenser containment. <br /> Yes I No I N/A Yes No N/A <br /> J10 1 ❑ I ❑ Dispenser- ❑ ❑ <br /> -0 ICU <br /> J - ❑ ❑ Dis enser- ❑ ❑ <br /> t <br /> - - - ❑ ElDis enser- 1:3 ® U <br /> r --.-p ❑ ❑ Dispenser I D 0, Z <br /> Q Jt <br /> PAPERWORK INSPECTION _ Yes No NIA j Date Done y1 � <br /> —I stem Certification was completed within the past 12 months? ❑ _❑ 9-L5_ :3 <br /> ectors were tested/certified within the past 12 months? ❑� ❑ (> -� <br /> r)ntainment structure)testing completed within the past 12 months? ❑ ❑ $ _ <br /> 11f testing completed within the required time frame? ❑ ❑_ ® r' <br /> Q ninment tests completed within the re uired time frame'? ❑ 2 ` - <br /> C <br /> _election colleted within the required time frame? ❑ ca <br /> cstin maintcnance was completed within required time frame? (List tesl,'maintenupice iiems below.) p <br /> Nainicnancc: (;SLD Uaily"fest Report - !� G't �'[(/ 'V_F 0 -� � <br /> � o°✓1aintrnance: <br /> !I I ;✓ <br /> FACILITY EMI'LOYLT TRAINING N es No \ <br /> :nrplu c e, n c c ivcd the retlimcd rm-the Wh u,tiiiin w ithin Ilii ha,l '.car" ❑ l <br /> n�t�r vr'_hucrl <br /> Willi iu Ilio 1rr,I ifl cla rccurccl 111C rccluirrrl un Ii inti Iralnln�LAy _ C <br /> :,n.✓zr, rn tl r r ttnin,,;ni. '('01on oil (11(. u <br /> hdjou � cr JmLlc. I hrtx i„uc, raluirr currccti�r!_action i'rotn <br /> r„tnr- E <br /> N.�N.unulnr�.urC <br />