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UNDERGROUND STORAGE TANK SYSTEM <br /> DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT <br /> Facility Name: National Petroleum Inspection Date: ' J/o <br /> Facility Address: 713 N EI Dorado St City: Stockton <br /> Name of Designated UST Operator Conducting Inspection: Niken Patel <br /> International Code Council Certification No.: 5243194-UC Expiration Date: 3/26/2017 <br /> Signature: Phone: (510)677-4467 ext. <br /> N/A=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? <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 report/logreporillog to this ins ection orm.) <br /> 4. Has each alarm for the revious month been res onded to a ro riatel ? 1171 <br /> UST SYSTEM INSPECTION <br /> 5. Are tank-top containment sumps free of water,debris,and hazardous substance? Note:If the answer to Item 4 was"Yes,".skip <br /> to Item 6. Sumps where 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 ver!fying appropriate service should be attached to this report. <br /> Yes I No Yej No ; <br /> Sump Location: 'r,� Sump Location: <br /> Sump Location: I El Sump Location: <br /> 6. Ares ill buckets(containment structures)free of water,debris,and hazardous substance? <br /> Yes No N/AI Yes No N/A <br /> Tank 1 1D— Tank 4 ID— <br /> Tank 2 ID— Tank 5 ID El Io I <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 Ygs No N/A <br /> Dispenser— 1/2 Dispenser—9/10 <br /> Dispenser—3/4 Dispenser— 11/12 <br /> Dispenser—5/6 Dispenser— 13/14 <br /> Dispenser—7/8 190 Dispenser— 15/16 El <br /> 8. Leak detection is properly located within under-dispenser containment. <br /> Ye No I N/A Yes No N/A <br /> Dispenser— 1/2 Dispenser—9/10 <br /> Dispenser—3/4 Dispenser— 11/12 <br /> Dispenser—5/6 0 1 Dispenser— 13/14 <br /> Dispenser—7/8 ❑ Dis enser— 15/16 <br /> y„_. ; <br /> PAPERWORK INSPECTION Yes I No I N/A Date Done <br /> 9. Monitoring System Certification was completed within the past 12 months? 10 1 EJ ElIj <br /> 10. Line Leak Detectors were tested/certified within the past 12 months? 1_5 <br /> 11. Spill bucket containment structure)testing completed within the past 12 months? 10 0c31 <br /> 12. Line tightness testing completed within the required time frame? <br /> 13. Secondary containment tests completed within the required time frame? ') Z l-� <br /> 14. Enhanced Leak Detection completed within the required time frame? 0 10 JW 1 <br /> 15. Other re uired test ing/mai ntenance was completed within required time frame? (List test/maintenance items below.) <br /> Describe Test/Maintenance: Li I Li <br /> Describe Test/Maintenance: U10 I El <br /> TWIT <br /> : <br /> FACILITY EMPLOYEE TRAINING Yes I No N/A <br /> 16. Have all facility employees received the required on-the-job training within the past ear? <br /> 17. 1 Have all facility employees hired within the past 30 days received the required on-the-job trainin .? <br /> Note: Explain any"No"answers in the"Comments"section on the following page.Those issues require corrective action from <br /> the UST owner/operator. <br /> UN-057-1/2 www.unidoea.org 9/26,115 <br /> JUN 02 2016 <br /> i <br />