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UNDERGROUND STORAGE TANK SYSTEM DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT Facility Name: National Petroleum Inspection Date: �ci1 i Facility Address: 713 N EI Dorado St City: Stockton Name of Designated UST Operator Conducting Inspection: Niken Patel International Code Council Certification No.: 5243194-UC Expiration Date: 3/26/2017 Signature: Phone: (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? 3. Is the Alarm History Report/log for the previous month available,and has it been reviewed by the Desi nated UST Operator? (Attach a copy o the alarm history reporillog to This ins ection orm.) 4. 1 Has each alarm for the revious month been res onded to a ro riatel ? r: ,,�. UST SYSTEM INSPECTION 5. Are tank-top containment sumps free of water,debris,and hazardous substance? Note:If the answer to Item 4 was-Yes,"skip 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 properly addressed the cause of the alarm.Documentation veri to a r riate service should be attached to this report. Yes No Yes No Sump Location: El Sump Location: ►`I='`Z Sump Location: I El Sump Location: 6. Ares ill buckets containment structures)free of water,debris,and hazardous substance? Yes No N/A Yes I No I N/A Tank 1 ID— I U I I Tank 4 ID— Tank 2 ID— Tank 5 ID— 0101 / Tank 3 ID— Tank 6 ID— 7. Are under-dispenser containment areas free of water,debris,and hazardous substance? YesI No N/A Yes No N/A Dispenser— 1/2 Dispenser—9/10 Dispenser—3/4 Dispenser— 11/12 Dispenser—5/6 Dispense — 13/14 Dispenser—7/8 Dispenser— 15/16 IT El 91 8. Leak detection is properly located within under-dis enser containment. Yes I No I N/AI Yes I No I N/A Dispenser— 1/2 Dispenser—9/10 Dispenser—3/4 Dispenser— 11/12 Dispenser—5/6 1 El I El Dispenser— 13/14 Dispenser—7/8 ❑ ❑ Dispenser— 15/16 ❑ PAPERWORK INSPECTION Yes. No N/A Date Done 9. MonitoringSystem Certification was completed within the past 12 months? L IS 10. Line Leak Detectors were tested/certified within the past 12 months? a' IL Spill bucket(containment structure)testingcompleted within the past 12 months? ski P 12. Line tightness testingcompleted within the required time frame? , 13. Secondarycontainment tests completed within the required time frame? ` & 5 I'> 14. Enhanced Leak Detection completed within the required time frame? 15. Other required testing/maintenance was completed within required time frame? (List test/maintenance items below.) Describe Test/Maintenance: Li I Li I Li Describe Test/Maintenance: I L1 10 10 FACILITY EMPLOYEE TRAINING Yes No N/A 16. Have all facility employees received the required on-the-job training within the past ear? LJ U I El 17. Have all facility employees hired within the past 30 days received the required on-the-job training.? Lj Note: Explain any"No"answers in the"Comments"section on the following page.Those issues require corrective action from the UST owner/operator. L fir ` UN-057-1/2 www.unidoc3.org 9/26/05 JUN 2 2(016 "`wP w tl 11— 1 1 t.td i.L1, .- l!L,.,,.L.