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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 /> Y' <br /> N/A=Not Applicable <br /> Item MONITORING PANEL/ALARM HISTORY Yes No I N/A <br /> 1. Is the monitoring system powered on and in proper operating mode? Z 1:11 11 <br /> 2. Is the monitoring system not current!y 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/logreporillog to this ins ection orm.) <br /> 4. 1 Has eac11 h alarm for the revious month been res onded to a ro riatel ? D 11 <br /> UST SYSTEM INSPECTION <br /> 5. Are tank-top containment sumps free of water,debris,and hazardous substance? Note:lfthe ansiver 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 o the alarm.Documentation vert in ro nate service should be attached to this report. <br /> Yes No Yes No <br /> Sum Location: Sum Location: 1-116' <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/ <br /> Tank 1 ID- Tank 4 ID- <br /> Tank 2 ID- PTank 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 I No N/A No N/A <br /> Dispenser- 1/2 Y Dispenser-9/10 _ <br /> Dispenser-3/4 Dispenser- 11/12 0 El 1771 <br /> Dispenser-5/6 El I El El I Dispenser- 13/14 <br /> Dispenser-7/8 1 Dispenser- 15/16 <br /> 8. Leak detection is properly located within under-dispenser containment. <br /> Yes I No I N/A YesI No I N/A <br /> Dispenser- 1/2 Dispenser-9/10 <br /> Dispenser-3/4 Dispenser- 11/12 <br /> Dispenser-5/6Dispenser- 13/14 <br /> Dis enser-7/8 <br /> EJOEl L <br /> ❑ Dispenser- 15/16 ❑ El <br /> PAPERWORK INSPECTION Ye5 No N/A Dlate one <br /> 9. Monito ing System Certification was completed within the past 12 months? <br /> 10. Line Leak Detectors were tested/certified within the past 12 months? Ed I El I El fl ,- <br /> 11. <br /> 11. S ill bucket(containment structure)testing completed within the past 12 months? <br /> 12. Line tightness testing completed within the required time frame? <br /> 13. Secondary containment tests completed within the required time frame? S aal a, <br /> 14. 1 Enhanced Leak Detection completed within the required time frame? RIO 1 <br /> 15. Other re uired testing/maintenance was completed within required time frame? (List testt'maintenance items below.) <br /> Describe Test/Maintenance: <br /> Describe Test/Maintenance: <br /> - <br /> FACILITY EMPLOYEE TRAINING Y No N/A <br /> 16. Have all facilityemployees received the required on-the-job trainingwithin the past ear? 0101 E <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-057-1/2 www.unidocs.org L Lr 9/26105 <br /> JUN 02 2016 <br />