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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 iC <br /> ouncil Certification No.: 5243194-UC Expiration Date: 3/26/2017 <br /> Signature: NA Phone: (510)677-4467 ext. <br /> N/A=NotAppficable <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 reporillog to this ins ection orm.) <br /> 4. 1 Has each alarm for the revious month been res onded to a ro riatel ? El <br /> UST SYSTEM INSPECTION <br /> 5. Are tank-top containment sumps free of water,debris,and hazardous substance? ,Vote:If rhe answer to Item J was"}es."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 vert <br /> . iM yEeropriate service should be attached to this report. <br /> Yes No Yes I No 7 <br /> Sump Location: 1- Sump Location: <br /> Sum Location: i Sum 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 I ID— Tank 4 1 D— <br /> Tank 2 ID— Tank 5 ID <br /> Tank <br /> DTank 3 ID— Tank 6 ID— <br /> 7. Are under-dispenser containment areas free of water,debris,and hazardous substance? <br /> Yes I No N/A I es No N/A <br /> Dispenser— 1/2 1 El Dispenser—9/10 <br /> Dispenser—3/4 Dispenser— 11/12 <br /> Dispenser—5/6 Dispenser— 13/14 <br /> Dispenser—7/8 #= Dispenser— 15/16 IE] I El <br /> 8. Leak detection is properly located within under-dispenser containment. <br /> Yes I No I N/A Yes I No N/A <br /> Dispenser— 1/2 Q. I El I Dispenser—9/10 1 El El <br /> Dispenser—3/4 Dispenser— 11/12 <br /> Dispenser—5/6 Dispenser— 13/14 <br /> Disenser—7/8 El El I ❑ Dis enser— 15/16 110 <br /> PAPERWORK INSPECTION Yes No IN/Al Pate Pone <br /> 9. Monitoring System Certification was completed within the past 12 months? El I El 101 1 W 115 <br /> 10. Line Leak Detectors were tested/certified within the past 12 months? I El I El 1 431 <br /> 11. Spill bucket(containment structure)testing completed within the past 12 months? d <br /> 12. Line tightness testing completed within the required time frame? El <br /> 13. 1 Second containment tests completed within the required time frame? n ` 1, 12 1 El I El <br /> 14. Enhanced Leak Detection completed within the required time frame? F1 I F1 I V1 <br /> 15. Other required testing/maintenance was completed within required time frame? List test/maintenance items below.) <br /> Describe TestlMaintenance: <br /> Describe Test/Maintenance: <br /> FACILITY EMPLOYEE TRAINING Y0 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 training.? <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-o57-Ir_ �.--a,*J' .+•s �I k o6j.�J.unidocs org � " '���� � �.+• 9/26/05 <br /> JUN 0 2s 2016 JUN 0 2 <br />