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UNDERGROUND STORAGE TANK SYSTEM <br /> DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT <br /> Facility Name: National Petroleum Inspection Date: s _3 0 , 1 <br /> Facility Address: 713 N EI Dorado St City: Stockton <br /> Name of Designated UST Operator Conducting Inspection: Niken Patel <br /> International Code Cou it Certification No.: 5243194-UC Expiration Date: 3/26/2017 <br /> Signature: Phone: (510)677-4467 ext. <br /> N/A=Not Applicable <br /> Item MONITORING PANEL/ALARM HISTORY YesNo N/A <br /> 1. Is the monitoringsystem powered on and in proper operating mode? <br /> 2. Is the monitoringsystem not current) showingan leak alarms? Ey <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 co o the alarm histo re ort/lo to this ins ection orm.) <br /> 4. Has each alarm for the previous 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:/f the answer to Item 4 was"Yes,"ship <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 veri in a ro nate service should be attached to this report. <br /> Yes No Yes o [.Fir <br /> Sum Location: Sum Location: i eS ` <br /> Sum Location: q l Sump Location: <br /> 6. Ares ill buckets(containment structures)free of water,debris,and hazardous substance? <br /> Yes_.No N/A I es No N/A <br /> Tank 1 ID— Tank 4 ID— <br /> Eal <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 I Yes No N/A <br /> Dispenser— 1/2 Disp enser—9/10 <br /> Dispenser—3/4 Dispenser—11/12 <br /> Dispenser—5/6 Dispenser—13/14 <br /> Dis nser—7/8 Dispenser— 15/16 <br /> 8. Leak detection is properly located within under-dis enser containment. <br /> Yes.1 No I N/A I Yes No I N/A <br /> Dispenser—1/2 1 El I El Dispenser—9/10 <br /> Dispenser—3/4 Dispenser—11/12 <br /> Dispenser—5/6 EjJ0 I Ej Dispenser— 13/14 El <br /> Dis enser—7/8 ❑ ❑ Dis enser— 15116El 10 <br /> PAPERWORK INSPECTION Yes No N/A Date Done <br /> 9. Monitoring System Certification was completed within the past 12 months? <br /> 10. Line Leak Detectors were tested/certifled within the past 12 months? Dr " <br /> 11. Spill bucket containment structure testing completed within the past 12 months? 17 El <br /> 12. Line ti htness testing completed within the required time frame? <br /> 13. Secondary containment tests completed within the required time frame? 3 tl <br /> 14. Enhanced Leak Detection completed within the required time frame? Li <br /> 15. Other required testing/maintenance was completed within required time frame? (List test/maintenance items below.) <br /> Describe Test/Maintenance: <br /> Describe Test/Maintenance: El El <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? al 0 1 11 <br /> 17. Have all facility employees hired within the past 30 days received the required on-the-job trainin 9.? <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-to www.unidocs.org 9/26/05 <br />