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UNDERGROUND STORAGE TANK SYSTEM DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT - Facility Name: Marigold Shell Inspection Date: I r G /Z: Facility Address: 6131 Pacific Avenue City: Stockton, California 95207 Name of Designated UST Operator Conducting Inspection: Kathy Kotulak -�o/o International Code/CZcil Certification No.: 5240722UC Expiration Date: Signature: - Phone: (925) 413-7422 ext. N/A=Not A plicabic 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 ils ❑ ❑ Designated UST Operator? Attach a copy of the alarm history report/logreport/log to this inspection orm. 4. Has each alar;n for the previous month been responded to ap ro riately? ❑ ❑ UST SYSTEM INSPECTION` 5. Are tank-top containment sumps free of water, debris, and hazardous substance? Note.If the answer to liem 4 was "Yes,"skip to Item 6. Sumps where an alarm has occurred in the past month must be inspected�f a qualified service technician has not responded to, and properly addressed,the cause of the alarm. Documentation vert ing appropriate service should be attached to this report. Ye' I No Ves No Sump Location: ❑ I Sump Location: ❑ ❑ Sump Location: ❑ I ❑ 11 Sump Location: ❑ 6. Ares ill buckets containment structures)free of water,debris, and hazardous substance? Yes No N/A Yes I No N/A Tank 1 ID-Regular-87 NJ ❑ I ❑ Tank 4 ID- 0 ❑ Tank 2 ID-Premium-91 ❑ ❑ Tank 5 ID- ❑ Tank 3 ID-Diesel#2 ❑ ❑ Tank 6 ID- ❑ ❑ Z 7. Are under-dispenser containment areas fre6 of water, debris, and hazardous substance? Yes No N/A Yes No N/A Dispenser- 1/2 N ❑ Dispenser- ❑ Dispenser-3/4 ❑ Dispenser- ❑ Dispenser-5/6 ❑ ❑ Dispenser- ❑ Dispenser-7/8 U I ❑ I ❑ Dispenser- El ❑ 8. Leak detection is properly located within under-dis enser containment. Yes I No I N/A Yes No N/A Dispenser- 1/2 511 ❑ I ❑ Dispenser- ❑ Dispenser-3/4 ® ❑ ❑ Dispenser- ❑ ❑ Dispenser--5/6 L9 I_❑ ❑ Dispenser- _ ❑ ❑ Dispenser-7/8 ❑ ❑ I Dispenser- ❑ El_ r, PAPERWORK INSPECTION Yes No N/A Date Done{ 9. MonitoringSystem Certification was completed within the past 12 months? ❑ ❑ - rU ' 10. Line Leak Detectors were t$sted/certified within the past 12 months? ❑ I N ❑ I - U 11. Spill bucket containment structure testing completed within the past 12 months? ❑ ❑ -rJ 0 12. Line tightness testing completed within the required time frame? ❑ lbi� 13. Secondary containment tests completed within the required time frame? ❑ gum; 14. Enhanced Leak Detection completed within the required time frame? ❑ I ❑ 15. Other required testing/maintenance was completed within required time frame? (List test/maintenance items below. Describe Test/Maintenance: Describe Test/Maintenance: ❑ ❑ FACILITY EMPLOYEE TRAINING Yes No N/A 16. Have all facilityemployees received therequired on-the-'ob training within the past ear? ❑ ❑ 17. 1 Have all facility employees hired within the past 30 days received the required on-the-'ob training.? ❑ ❑ Note: Explain any"No"answers in the "Comments" section on the following page. Those issues require corrective action 6om the UST owner/operator. UN-057-1/1 www.unidoes.org 9/26/05