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UNDE sROUND STORAGE TAi .__ . SYSTEM DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT Facility Name: Marigold Shell Inspection Date: la Facility Address: 6131 Pacific Avenue City: Stockton, lifo a 95207 Name of Designated UST Operator Conducting Inspection: Kathy Kotulak International C e ouncil Certification No.: 5240722UC Expiration Date: 8/7/2010 Signature: f/`lam L� Phone: (925) 413-7422 ext. N/A=Not Applicable Item MONITORING PANEL/ALARM HISTORY Yes No N/A 1. Is the monitoring system powered on and in proper operating mode? 2. Is the monitoring system not currently showing any leak alarms? 3. Is the Alarm History Report/log for the previous month available, and has it been reviewed by the ❑ ❑ Designated UST Operator? Attach a copy of the alarm history report/logreport1log to this inspection orm. 4. Has each alarm for the Irevious month been responded to appropriatel ? UST SYSTEM INSPECT10N 5. Are tank-top containment sumps free of water, debris, and hazardous substance? Note: If the answer to Item 4 was "Yes,"skip to Item 6. Sumps where an alarm has occurred in the past month must be inspected if a qualified service technician has not responded to. and properly addressed,the cause of the alarm. Documentation vertAing yppropriate service should be attached to this report. Ye! No Ye! No Sump Location: 1011Sump Location: El El Sum Location: EED I LED Sum Location: ❑ ❑ 6. Ares ill buckets(containment structures) free of water,debris, and hazardous substance? Yes No N/A Yes No N/A Tank 1 ID—Regular- 87 ❑ ❑ Tank 4 ID— ❑ ❑ -Tank 2 ID—Premium-91 ❑ ❑ Tank 5 ID— ❑ ❑ Tank 3 ID—Diesel#2 ❑ I ❑ Tank 6 ID— ❑ 7. Are under-dispenser containment areas free of water,debris, and hazardous substance? Yes No N/A Yes No N/A Dispenser— 1/2 ❑ ❑ Dispenser— ❑ Dispenser—3/4 ❑ Dispense — ❑ ❑ Dispenser—5/6 ❑ El Dispenser— ❑ Dispenser—7/8 Y I ❑ I ❑ Dispenser— ❑ ❑ l 0 8. Leak detection is properly located within under-dispenser containment. Yes No N/A Yes No N/A Dispenser— 1/2 E 0 ❑ Dispense — ❑ Dispenser—3/4 ❑ ❑ Dispense — ❑ I ❑ Dispenser—5/6 ❑ ❑ Dispenser— ❑ Dispenser—7/8 ❑ Disppenser ❑ PAPERWORK INSPECTION Yes I No N/A Date Done 9. Monitoring System Certification was completed within the past 12 months? ! ' L, c`' 10. Line Leak Detectors were tested/certified within the past 12 months? 01 ❑ ❑ 11. Spill bucket containment structure testing completed within the past 12 months? ❑ ❑ ' /. 12. Line tightness testing completed within the required time frame? ❑ ® l 13. Second containment tests completed within the required time frame? ❑ ❑ 14. Enhanced Leak Detection completed within the required time frame? ❑ ❑ 1Z I - 15. Other required testing/maintenance was completed within required time frame? List test/maintenance items below. P&ECT Describe Test/Maintenance: I Ll I ❑ 10 Describe Test/Maintenance: j.EJj FACILITY EMPLOYEE TRAINING Yes I No N/A 16. Have all facility employees received the required on-the-job training within the past ear? 17. Have all facili em to ees hired within the past 30 days received the required on-the-'ob training.? ❑ I ❑ I TO Note: Explain any"No" answers in the "Comments" section on the following page. Those issues require corrective action from the UST owner/operator. UN-057-1/1 www.unidocs.org 9/26/05