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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: (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 cop),o the alarm history report/logreportllog to this ins ection orm.) <br /> 4. Has each alarm for the revious month been res onded to a ro riatel ? El 1 11 <br /> tai <br /> UST SYSTEM INSPECTION <br /> 5. Are tank-top containment sumps free of water,debris,and hazardous substance? Note:ff rhe answer to Item d 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 10,and <br /> properly addressed the cause o the alarm.Documentation verifying appropriate service should be attached to this report, <br /> Yes No Ye No <br /> Sump Location: Sump Location: Gil 111 El <br /> Sump Location: Sum Location: <br /> 6. Ares ill buckets(containment structures)free of water,debris,and hazardous substance? <br /> Yes No N/A I es I No I N/A <br /> Tank l ID- I Tank 4 ID- <br /> Tank 2 ID- 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 /> YesI No N/A Yes I No I N/A <br /> Dispenser- 1/2 Dispenser-9/10 <br /> Dispenser-3/4 Dis enser- 11/12 <br /> Dispenser-5/6 1 El I Dispenser- 13/14 <br /> :P- <br /> Dispenser-7/8 A Dispenser- 15/16 <br /> 8. Leak detection is properly located within under-dispenser containment. <br /> Y No I N/A Yes NoI NIA <br /> Dispenser- 1/2 1 El Dis enser-9/10 <br /> Dispenser-3/4 Dispenser- 11/12 L <br /> Dispenser-5/6 Dis enser- 13/14 _ <br /> Dispenser-7/8 ❑ ❑ Dis enser- 15/16 ❑ <br /> PAPERWORK INSPECTION Yes No N/A D to Qone <br /> 9. Monitoring System Certification was completed within the past 12 months? j <br /> 10. Line Leak Detectors were tested/certified within the past 12 months? i <br /> 11. Spill bucket(containment structure)testing completed within the past 12 months? l j <br /> 12. Line tightness testing completed within the required time frame? <br /> 13. Second containment tests completed within the required time frame? 5 ►� <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.) <br /> Describe Test/Maintenance: <br /> Describe TestfMaintenance: <br /> FACILITY EMPLOYEE TRAINING Yes 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 .? <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-IR L`...-J .#L,%w 6,,,..-_www.unidoc&org 9/26/05 <br /> JUN 0 2 2016 JUN 02 <br />