Laserfiche WebLink
� r <br /> UNDERGROUND STORAGE TANK SYSTEM <br /> DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT <br /> Facility Name: National Petroleum Inspection Date: 1 3G 1 <br /> Facility Address: 713 N EI Dorado St City: Stockton <br /> Name of Designated UST Operator Conducting Inspection: Niken Patel <br /> International Code C uncil Certification No.: 5243194-UC Expiration Date: 3/26/2017 <br /> Signature: Phone: (510)677-4467 ext. <br /> N/A m Not Applicable <br /> Item MONITORING PANEL/ALARM HISTORY Yes No N/A <br /> 1. Is the monitoring system powered on and in proper operating mode? <br /> 2. Is the monitoring system not currently showing any leak alarms? CT IT <br /> 3. Is the Alarm History Report/log for the previous month available,and has it been reviewed by the <br /> Designated UST Operator? (Attach a copy o the alarm history reportllog to this ins ction orm.) <br /> 4. Has each alarm for the revious month been res onded to a ro riatel ? <br /> UST SYSTEM INSPECTION <br /> 5. Are tank-top containment sumps free of water,debris,and hazardous substance? ,Vote:!f rhe answer to Item 4 was"Yes,-skip <br /> to Item 6. Sumps inhere an alarm has occurred in the past month must be inspected if a qualified service technician has not responded to. and <br /> properly addressed,the cause of the alarm.Documentation verifying riate service should be attached to this report <br /> Yes No Yes No <br /> Sump Location: I Sum Location: Q/0Sd i ' <br /> Sum Location: Sump Location: <br /> 6. Ares ill buckets containment structures)free of water,debris,and hazardous substance? <br /> Yes No N/AI Yes I No I N/A <br /> Tank l ID— Tank 4 1D— <br /> Tank 2 ID— Tank 5 ID E1101 0 <br /> — <br /> Tank 3 ID— Tank 6 ID— <br /> 7. Are under-dispenser containment areas free of water,debris,and hazardous substance? <br /> Yes I No I N/A Yes No I N/A <br /> Dispenser— 1/2 1 El Dispenser—9/10 1:1 1 E01 <br /> Dispenser—3/4 Dispenser— 11/12 <br /> Dispenser—5/6 Dispenser— 13/14 El <br /> Dispenser—7/8 Dispenser 15/16 10 <br /> 8. Leak detection is properly located within under-dispenser containment. <br /> Ye,%I No I N/A I No I N/A <br /> Dispenser— 1/2 0 U I Dispenser—9/10 <br /> Dispenser—3/4 El Dispenser— 11/12 <br /> Dispenser—5/6 Dispenser— 13/14 <br /> Dispenser—7/8 ❑ El I Dis enser— 15/16 ❑ <br /> PAPERWORK INSPECTION Yes No N/A Rate Pone <br /> 9. Monitoring System Certification was completed within the past 12 months? �5 <br /> 10. Line Leak Detectors were tested/certified within the past 12 months? I U I U < I <br /> 11. Spill bucket containment structure)testing completed within the past 12 months? <br /> 12. Line tightness testing completed within the required time frame? <br /> 13. Secondary containment tests completed within the required time frame? 771 3�- 3 <br /> 14. Enhanced Leak Detection completed within the required time frame? <br /> 15. Other required testing/maintenance was completed within required time frame? (List testlmaintenance items below. <br /> Describe Test/Maintenance: <br /> Describe Test/Maintenance: <br /> FACILITY EMPLOYEE TRAINING Y No N/A <br /> 16. Have all facility employees received the required on-the-job training within the past ear? <br /> 17. Have all facility employees hired within the past 30 days received the required on-the-job trainin .? U El <br /> Note: Explain any"No"answers in the"Comments"section on the following pa e. ose.Issti s relqZoe;co`rrective action from <br /> the UST owner/operator. � , "'6 <br /> UN-057-112 www.uniclocs org 9126/05 <br /> JUN 0 2 2016 <br />