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UNDERGROUND STORAGE TANK SYSTEM DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT Facility Name: National Petroleum Inspection Date: S - 3 Facility Address: 713 N EI Dorado St City: Stockton Name of Designated UST Operator Conducting Inspection: Niken Patel International Code Cou it Certification No.: 5243194-UC Expiration Date: 3/26/2017 Signature: Phone: �A (510)677-4467 ext. N/A=Not Applicable Item MONITORING PANEL/ALARM HISTORY Yes No N/A 1. Is the monitoring system powered on and in proper operating mode? 2 Is the monitoring system not currently showing any leak alarms? 7T [] 3. Is the Alarm History Report/log for the previous month available,and has it been reviewed by the 7T ❑ Designated UST Operator? (Attach a copy of the alarm history reportllog to this ins ection form.) 4. revious month been res onded to appropriat elgeach alarm for thel ? [] UST SYSTEM INSPECTION 5. Are tank-top containment sumps free of water,debris,and hazardous substance? Vote:If the an.nver to Item d was "}es.-skip to Item 6. Sumps where an alarm has occurred in the past month must be inspected ria qualified service technician has not responded to. and properly addressed the cause of the alarm.DocumeNat ton veri ing appropriate service should be attached to this report. Yes No Yes o Sum Location: Sum Location: i�_S e- Sum Location: q 1 Sump Location: 6. Ares ill buckets(containment structures)free of water,debris,and hazardous substance? Yes No N/A Yes No N/A Tank I ID— I Tank 4 1 D— Tank 2 ID— Tank 5 ID— Tank 3 ID— I Lu =41 Lj I Ll I Tank 6 ID— 7. Are under-dispenser containment areas free of water,debris,and hazardous substance? Yes No N/A Yes No N/A Dispenser— I/2 Dispenser—9/10Er Dispenser—3/4 Dispenser— 11/12 Dispenser—5/6 Dis enser— 13/14 Dispenser—7/8 al ❑ 1 0 Dispenser— 15/16 8. Leak detection is properly located within under-dispenser containment. Yes I No I N/A Yes No N/A Dispenser— 1/2 0.1 ❑ I Dispenser—9/10 Dispenser—3/4 Dis enser— 11/12 Dispenser—5/6 Dispenser— 13/14 1 El Dispenser—7/8 ❑ ❑ Dispenser— 15/16 ❑ ❑ PAPERWORK INSPECTION Yes. No N/A Date Done P12. MonitoringSystem Certification was completed within the past 12 months? S b Line Leak Detectors were tested/certified within the past 12 months? " Spill bucket(containment structure)testingcompleted within the past 12 months? Line ti htness testin com leted within the re uired time frame?Second containment tests completed within the required time frame? 3 I 14. Enhanced Leak Detection completed within the required time frame? 10 El 01 15. Other required testing/maintenance was completed within required time frame? (List test/maintenance items below.) Describe Test/Maintenance: Describe Test/Maintenance: 7, , �, , FACILITY EMPLOYEE TRAINING Yes No N/A 16. Have all facility employees received the required on-the-job training within the past ear? 17. Have all facility employees hired within the 2ast 30 days received the required on-the-job trainin .? Note: Explain any"No"answers in the"Comments"section on the following page.Those issues require corrective action from the UST owner/operator. a 1'N-057-1/2 www.unid"s.org ��a e>b»n �""' — 9/26/05 JUN 02 2016 3►t^i