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UNDERGROUND STORAGE TANK SYSTEM <br /> DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT <br /> Facility Name: National Petroleum Inspection Date: <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: <br /> (510)677-4467 ext. <br /> N/A=Not A jAicable <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 of the alarm history report/logreportllog to this ins ection orm.) <br /> 4. Has each alarm for the revious month been responded to a ro riatel ? Eli El <br /> WlKi <br /> UST SYSTEM INSPECTION <br /> 5. Are tank-top containment sumps free of water,debris,and hazardous substance? Note:/f the answer to Item d was-Yes,"skip <br /> to Item 6. Sumps where an alarm has occurred in rhe past month must be inspected if a qualified service technician has not responded to, and <br /> property addressed the cause of the alarm.Documentation vert in a ro riate service should be attached to this report. <br /> Yes No Yes No <br /> Sum Location: _ Sum Location: <br /> Sum Location: n r Sum Location: <br /> 919] <br /> 6. Ares ill buckets(containment structures)free of water,debris,and hazardous substance? <br /> Yes No N/AI Yes No I N/ <br /> Tank I ID— Tank 4 1D— <br /> Tank 2 ID— 01 Tank 5 ID— <br /> Tank 3 ID— Tank 6 ID— <br /> 7. Are under-dispenser containment areas free of water,debris,and hazardous substance? _ <br /> Yes I NoI N/A I es I No I N/A <br /> Dispenser— 1/2 E71 Li 1 01 1 Dispenser-9/10 El I <br /> Dispenser—3/4 Dispenser— 11/12 El I El <br /> Dispenser—5/6 Dispenser— 13/14 <br /> Dispenser—7/8 1 1 Dispenser— 15/16 #ff4 <br /> 8. Leak detection is properly located within under-dispenser containment. <br /> Yes I No I N/A Ygs I No N/A <br /> Dispenser— 1/2 Dispenser—9/10 <br /> Dispenser—3/4 Dispenser— 1 1/12 101 10 1 <br /> Dispenser—5/6 Dispenser— 13/14 11 El IE <br /> Dis enser—7/8 Dis enser— 15/16 <br /> PAPERWORK INSPECTION es No N/A Datio Done <br /> 9, Monitoring System Certification was completed within the past 12 months? Ej I Li IIS <br /> 10. Line Leak Detectors were tested/certified within the past 12 months? <br /> 11. Spill bucket containment structure testing completed within the past 12 months? s <br /> 12. Line tightness testing completed within the required time frame? <br /> 13. Secondarycontainment tests completed within the required time frame? °�� a3hS <br /> 14. Enhanced Leak Detection completed within the required time frame? <br /> 15. Other re uired test in maintenance was completed within required time frame? (List test/maintenance items below)L <br /> Describe Test/Maintenance: <br /> Describe Test/Maintenance: <br /> FACILITY EMPLOYEE TRAINING Yes I No I 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 .? <br /> Note: Explain any"No"answers in the"Comments"section on the following page.Those issues require corrective action from <br /> the UST owner/ope t�{. <br /> UN-057-1R Mn+w.unidocs.org 9/26/05 <br /> JUN 02 2016 JUN 02 <br />