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Designated Underground Storage Tank (USAperator <br /> Monthly Visual Inspection Checklist <br /> (%', Facility Name: 99 Shell Date: 9AWW 3 3 i- <br /> - icili ' Address:7700 Moreland Ct <br /> City: Stockton Zi Code-. <br /> Designated UST Operator Conducting the Inspection: Lori Freshour. <br /> International Code Council Certification#: 5220353-UC Expiration Date: 9/17/07 <br /> Signature: t, . Phone:- (916)826-1576 <br /> Item MONITORING PANEL ALARM HISTORY Y N NA <br /> 1 Monitorin•system is powered on and in proper otigxating mode <br /> 2 Monitorings ern is not currently showing alarms or warnings <br /> 3 Alarm history report/log for the previous month is available,and has been reviewed by the grated UST Operator. <br /> (Attach a copy of the alarm history report/log to this orm if available) / <br /> Fach alarm for the previous month has been responded to appropriately. <br /> 5 Sensorl looted in the tank-top containment sumps have not alanr:d in the past month <br /> •5a List all tank-lop 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 N <br /> properly addressed,the cause of the alarm. Attach documentation verifying appropriate s;rwce to this report- <br /> lj"sump Aspection 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 properly located <br /> Note Visual=4=Wn of sumps is ordy regured in suisps where an alarm has omsred in the t month for which there is no service record <br /> Y N Y N <br /> Sump Location: Sump Logon. <br /> Sump Loon: Sump Location: <br /> Sum Location: Sump Logon: <br /> 7 Spill containment structures are free of water,debris,and hazardous substance. <br /> Y N NA - Y N NA <br /> Tank 1-Contents t_ Tank 3-CbWents = <br /> _ Tank 2-ConterdS 1P 0,C-- tv Tank 4-Contents la <br /> 8 UDC areas are free of water,debris,and hazardous substance. Sensors are'property totaled <br /> Y N NA Y N NA <br /> Dispenser 1/2 Di, ' nser 9/10 N F <br /> Dispenser 3/4 Di flser 11/12 >v <br /> Dispenser 5/6 Dispenser 12/13 ni <br /> Doenser 718 Di riser 14/15 NLA <br /> PAPERWORK INSPECTION Y N NA RDAT7EDONE�9 Monitori s tem certification has beenlenenact within the t 12 months.10 Secondary Contaimt tests have been eted within the red timeframN e.11 11 containment structure et testiwas eted within the t ear. <br /> 12 Tank tightness,testing was completed within required timeframe. <br /> 13 Line titress testing was conoeted with reWimd timeframe. <br /> 14 Other required testing maintenance was completed within required tiList test/maintenance items below <br /> Test/Maintenance: L.: i- <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> FACILITY EMPLOYEE TRAINING = ' Y N NA <br /> 15 All farAdy ernploreceived the required ort- ob b-aning within the Oastyw. <br /> IQ- 'All facility tined within the past 30 clay have received the mWmd ori; nob training <br /> NOW Any answer of"N"should bdvoaiined in the cornment section on the following page,and will require fellow-up action. <br /> Curetments: <br /> Follow-up action required: L' l 1 _ <br /> r II l ' D <br /> CC \tj V�C K.' L. ;CHIC' <br /> DeaWrI Manager Sigrititure: Date: 3� 0 <br /> n <br />