Laserfiche WebLink
UNDERGROUND STORAGE TANK SYSTEM <br /> DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT <br /> Facility Name: National Petroleum Inspection Date: 1 j <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=Nota iieanie <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 report/logreport/log to this ins ection orm.) <br /> 4. Has each alarm for the revious month been res onded to a ro riatel ? Q El <br /> UST SYSTEM INSPECTION <br /> 5. Are tank-top containment sumps free of water,debris,and hazardous substance? Note:IJ the answer to Item 4 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 to,and <br /> properly 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: t l! <br /> Sum Location: I Sum Location: ( ' <br /> 6. Ares ill buckets(containment structures)free of water,debris,and hazardous substance? <br /> Yes No N/A Yes No N/A <br /> Tank l ID— Tank 4ID— <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 /> Yes No I N/A Yes No N/A <br /> Dispenser— 1/2 Dispenser—9/10 <br /> Dispenser—3/4 Dispenser— 11/12 _ <br /> Dispenser—5/6 Dispenser— 13/14 11 1 El <br /> Dispenser—7/8 Lj Lj I Dispenser— 15/16 <br /> 8. Leak detection is properly located within under-dispenser containment. <br /> Yes I No I N/A Yes No N/A <br /> Dispenser— 112 Q I El 01 Dispenser—9/10 Oil 1 1:1 <br /> Dispenser—3/4 0 Dispenser 11/12 <br /> Dispenser—5/6 Dispenser— 13/14 <br /> Dispenser—7/8 ❑ ❑ I Dis enser— 15/16 111 El I <br /> • : <br /> PAPERWORK INSPECTION Yes No N/A to Don <br /> 9. MonitoringSystem Certification was completed within the past 12 months? -(' 1 <br /> 10. Line Leak Detectors were tested/certified within the past 12 months? 4 �S <br /> 11. Spill bucket containment structure)testing completed within the past 12 months? 9 )5� ai 13 <br /> 12. Line tightness testing completed within the required time frame? <br /> 13. Secondary containment tests completed within the required time frame? ? 5 aj 113 <br /> 14. Enhanced Leak Detection completed within the required time frame? <br /> 15. Other re uired testing/maintenance was completed within required time frame? (List test/maintenance items below.) <br /> Describe Test/Maintenance: <br /> Describe Test/Maintenance: <br /> %3W MINOR <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-057-1/2 www.unidocs.org 9/26/05 <br /> JUN 02 2016 <br />