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.� `Designated Underground Storage Tank (UST) Operator <br /> Monthly Visual Inspection Checklist <br /> Facility Name: Manteca Express Date: 03/23/09 <br /> Facility Address:419 S. Main St <br /> City: Manteca Zip Code:95336 <br /> Designated UST Operator Conducting the Inspection: Karen R Amaiz <br /> International ode Council Certification#: 5266643-UC Expiration Date: 07/16/09 <br /> Signature: Phone: (209)5184836 <br /> V=Yes,N=No,NA=Not A livable <br /> Item MO ING PANEL/ALARM HISTORY Y I N NA <br /> I Monitoring system is powered on and in proper operating mode. X <br /> 2 Monitoring system is not currently showing any alarms or warnings. X <br /> 3 Alarm history report/log for the previous month is available,and has been reviewed by the X <br /> Designated UST Operator. (Attach a copy of the alarm history report/log report/logto thisform if available.) <br /> 4 Each alarm for the previous month has been responded to appropriately. X <br /> 5 Sensors located in tank-top containment sumps have not alarmed in the past month. X <br /> 5a _ List all tank-top 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 <br /> properly addressed,the cause of the alarm.Attach documentation verging 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 located properly. <br /> Note: Visual inspection of sums is only re uired in sumps where an alarm has occurred in the past month or which there is no service record. <br /> Y N Y N <br /> Sump Location: X <br /> Sump Location: X <br /> Sump Location: X <br /> 7 Spill containment structures are free of water,debris,and hazardous substance. <br /> Y N NA Y N NA <br /> Tank I —Contents:91 X Tank 3—Contents:Diesel X <br /> Tank 2—Contents:87 X <br /> 8 Under-dispenser containment areas are free of water,debris,and hazardous substance. Sensors are located properly. <br /> Y N NA Y N NA <br /> Dispenser 1/2 X <br /> Dispenser 3/4 X <br /> PAPERWORK INSPECTION Y N NA DATE DONE <br /> 9 Monitoring system certification has been completed within past 12 months. X 04/09/08 <br /> 10 Secondary containment tests have been completed within the required timeframe. X 03/14/06 <br /> 11 Spill containment structure(bucket)testing was completed within the past year. X 04/09/08 <br /> 12 Tank tightness testing was completed within required timeframe. <br /> 13 Line tightness testing was completed within required timeframe. <br /> 14 Other required testing/maintenance was completed within required timeframe. (List test/maintenance items below.) <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> FACILITY EMPLOYEE TRAINING Y N NA <br /> PI <br /> 5 All facili em to ees have received the re ired on-the-'ob trainin within the ast ear.05/28/08 X6 All facili employees hired within the past 30 days have received the required on-the-job training. ±:X= <br /> Note: Any answer of'IN"should be explained in the comment section on the following page,and will require <br /> follow-up action. <br /> Page 1 of 2 November 2004 <br />