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• Designated Underground Storage Tank (UST) % perator <br /> Monthly Visual Inspection Checklist <br /> Facility Name: Miramar Ente rises-,&xxm q - Date: -Z,-i—O <br /> Facility Address: <br /> CIT- <br /> City Stockton Zip Code: 9 Z 6 Z <br /> Designated UST Operator Conducting the Inspection:' Lori Freshour ' • <br /> Ipternational Code Council Certification#: 5220353-UC Expiration Date: 10/16/05 <br /> Signature: • Phone: (916)826-1576 <br /> Item MONITORING PANT?I. AIARM HISTORY Y N NA <br /> 1 Monitoring system is powered on and in proper operating mode <br /> 2 Monitoring system is not currently showing any alarms or warnings <br /> 3 Alarm history report/log for the previous month is available,and has been reviewed by the Designated t IST Operator. <br /> Attach u copy of the alarm history re ort l log to this orm i available) 7 <br /> 4 Each alarm for the previous month has been responded to appropriately. <br /> 5 Sensors located in the lank-top containment sumps have not alarmed in the past month <br /> 5a List all tank-top sumps where alarms occurred in the past month:__ _1PCLl--_ <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 verifying 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 properly located. <br /> Note Visual inspection of sums is only required in sums where an alarm has oacured in the past month for which there is no service record <br /> Y N Y N <br /> Sump Location: Sump bxaboft�-� <br /> Sump Location: — y Sump Loc9on: <br /> Sump Location: Sump Location: <br /> 7 Spill containment structures are free of water,debris,and hazardous substance. <br /> Y N NA Y N NA <br /> Tank 1 -ContentsJ: Tank 3-Contents 1 <br /> Tank 2-Contents j0po Tank 4-Contents N R <br /> 8 UDC areas are free of water,debris,and hazardous substance. Sensors are properly located <br /> Y N NA Y N NA <br /> Dispenser 1/2 Dispenser 9/10 typ <br /> Dispenser 3/4 Dispenser 11/12 AtA <br /> Dispenser 5/6 Dispenser 12/13 <br /> --tDispenser 718 V A POrz lis <br /> PAPERWORK INSPECTION Y N NA DATE DONE <br /> 9 Monitoring system certi cation has been competed within the past 12 months. -q-6 S <br /> 10 Secondary Containment tests have been completed within the required timeframe. lvdqfN� <br /> 11 Spill containment structure bucket testing was com eted within the past year. - -d <br /> 12 Tank tightness testing was completed within required timeframe. NA <br /> 13 Line tightness testing was completed with required timeframe. N A <br /> 14 Other required testing maintenance was completed within required timeframe. List teW maintenance items below <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> 4— <br /> Test/Maintenance: <br /> • FACIUTY EMPLOYEE TRAINING Y N NA <br /> 15 All facility em to ees have received the required on-thajob training within the past year. y <br /> 16 All facility employees hired within the past 30 day have received the required on-the-ob training ` <br /> Note:Any answer of"N"should be explained in the comment section on the following page,and will require follow-up action. <br /> Comments: -T k) 11j/N(±j C'0 M IOc-t"l t�-D - - 05- <br /> Follow-up <br /> 5- <br /> Follow-up action required: <br /> 0. <br /> joy <br /> Dever I Manager Signature: Date: <br />