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UNDERGROUND STORAGE TANK SYSTEM DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT Facility Name: National Petroleum Inspection Date: Facility Address: 713 N EI Dorado St City: Stockton Name of Designated UST Operator Conducting Inspection: Niken Patel International Code Council Certification No.: 5243194-UC Expiration Date: 3/26/2017 Signature: Phone: (510)677-4467 ext. NIA m Not Applicable F2. MONITORING PANEL/ALARM HISTORY Yes No N/A Is the monitorin s stem owered on and in ro er o eratin mode? F1 D ELIs the monitorin s stem not current) showin an leak alarms? ❑Is the Alarm History Report/log for the previous month available,and has it been reviewed by the Designated UST O erat-9 (Attach a co o the alarm history report1log to this ins ectiort orm.) 4. 1 Has each alarm for the revious month been res onded to a ro riatel ? El UST SYSTEM INSPECTION 5. Are tank-top containment sumps free of water,debris,and hazardous substance? Note:If the annver to Item 4 was"Yes,-skip 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 properly addressed,the cause o the alarm.Documentation verifying appropriate service should be attached to this report. Yes No YCs No :4.` Sump Location: / Sump Location: (?,; Sump Location: EA I..El 0 Sump Location: Rti',J 6. Ares ill buckets(containment structures)free of water,debris,and hazardous substance? Yes No N/AI Yes I No I N/A Tank I ID– Tank 4 ID– Tank 2 ID– Tank 5 ID– Tank 3 ID– Tank 6 ID– Li I Li I I 7. Are under-dispenser containment areas free of water,debris,and hazardous substance? Yes I No N/A I Yes No N/A Dispenser– 1/2 Dispenser–9/10 Dispenser–3/4 + Dispenser– 11/12 Dispenser–5/6 El Ej Dispenser– 13/14 1:1 El Dispenser–7/8 Dispenser– 15/16 01 ' 8. Leak detection is properly located within under-dispenser containment. Yes I No I N/A Yes I No I N/A Dispenser– 1/2 Dispenser–9/10 Dispenser–3/4 0. Dispenser– 11/12 Dispenser–5/6 M. Dis enser– 13/14 L Dispenser–7/8 0 Ej El Dis enser– 15/16 PAPERWORK INSPECTION Yes No N/A Date D ne 9. Monito ing System Certification was completed within the past 12 months? ' S 10. Line Leak Detectors were tested/certified within the past 12 months? I 11. Spill bucket(containment structure)testing completed within the past 12 months? i 12. Line ti htness testing completed within the required time frame? 13. Secondary containment tests completed within the required time frame? 17f' 14. Enhanced Leak Detection completed within the required time frame? 15. Other re uired testis maintenance was completed within required time frame? List test/maintenance items below.) Describe Test/Maintenance: I Li Li Describe Test/Maintenance: FACILITY EMPLOYEE TRAINING Yps No N/A 16. Have all facility employees received the required on-the-job mining within the past ear? Ll I El I El 17. Have all facility employees hired within the past 30 days received the required on-the-job train in .? Note: Explain any"No"answers in the"Comments"section on the following pate.Those issues require corrective action from the UST owner/operator. -- UN-057-1/2 www.unidoes.org LW 6.6.. 9/26/05 JUN 0 2 2016