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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 r <br /> ouncil Certification No.: 5243194-UC Expiration Date: 3/26/2017 <br /> Signature: Phone: (510)677-4467 ext. <br /> N/A=NotAppficable <br /> Item MONITORING PANEL/ALARM HISTORY Yes No I 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? IT <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/logreportllog to this ins ection orm.) <br /> 4. Has each alarm for the revious month been res onded to a ro riatel ? <br /> UST SYSTEM INSPECTION <br /> 5. Are tank-top containment sumps free of water,debris,and hazardous substance? Note:If the onsiver 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 verifying appropriate service should be attached to this report. <br /> Yes No <br /> Sump Location: Sump Location: c p <br /> Sump Location: Sump Location: <br /> 6. Ares ill buckets(containment structures)free of water,debris,and hazardous substance? <br /> Yes No N/AI es No N/ <br /> Tank 1 ID— Tank 4 ID— <br /> 'rank 2 ID— Tank 5 ID Ell <br /> — <br /> Tank 3 ID— t1 Fj I El I Tank 6 ID El I El <br /> 7. <br /> D- <br /> 7. Are under-dispenser containment areas free of water,debris,and hazardous substance? <br /> Yes I No I N/A Yes No I N/A <br /> Dispenser— 1/2 El El Dispenser—9/10 <br /> Dispenser—3/4 Lj Dispenser— 11/12 <br /> Dispenser—5/6 Dispenser— 13/14 LA <br /> Dispenser—7/8 Dispenser— 15/16 El 0 <br /> 8. Leak detection is properly located within under-dispenser containment. <br /> Ye No I N/A Yes No I N/A <br /> Dispenser— 1/2 Dispenser-9/10 I El I El <br /> Dispenser—3/4 Dispenser— 11/12 <br /> Dispenser—5/6 Dispenser— 13/14 <br /> Dispenser—7/8 E31 ❑ Dis enser— 15/16 <br /> PAPERWORK INSPECTION Yes No N/A D to one <br /> 9. Monitoring System Certification was completed within the past 12 months? 15 <br /> 10. Line Leak Detectors were tested/certified within the past 12 months? <br /> 11. Spill bucket(containment structure)testing completed within the past 12 months? 15 <br /> 12. Line tightness testing completed within the required time frame? <br /> 13. Secondary containment tests completed within the required time frame? �W <br /> _:F 11 11 Vil B <br /> 14. Enhanced Leak Detection completed within the required time frame? <br /> 15. Other required test ing/mai ntenance was completed within required time frame? List test/maintenance items below) <br /> Describe Test/Maintenance: Li I Li <br /> Describe Test/Maintenance: El 10 <br /> FACILITY EMPLOYEE TRAINING y Yes No N/A <br /> 16. Have all facility employees received the required on-the-job training within the past ear? <br /> 17. 1 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 torr ive action from <br /> the UST owner/operator. -- <br /> UN-057-1/2 www.uuidoes.org L 926/05 <br /> JUN 0 2 2016 <br />