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FROM & FAX NO. un. 19 2013 04:29PM P4 <br /> UNDERGROUND STORAGE TSYSTEM <br /> DESIGNATE LIST OPE T U T LY N PCI N REPORT <br /> Facility Nance: SB Gas&Ma"t Inspection Date: <br /> April 14., 2013 <br /> Facility Address: 515 W 11th St. r City, Tracy <br /> Name of Designated BUST Operator Conducting Inspection: Robert Barnhart <br /> international G a ertificatian No.: 5252 0-UC Expiration Date: 1128/2014 <br /> Signature, .�- �` Rhone: (209)604-9336 ext. <br /> - •—' A ictA We <br /> Item MONITORING PANEL/AL N/A-+Alat <br /> •. HISTORY Yes t N/A <br /> 1. Is the monitor}n s sterna wered on and in proper2perating mode? <br /> 2, is the monitoring s stern not currently showin an leak alarms? <br /> 3. Is the Alarm History Report/log for the previous month available,and has it been reviewed'by the <br /> Des' ted UST Oerator? Attach a copy of e alarm histo re rt/tog to this itzspection form-) <br /> _ th <br /> 4. Has each alarm for the DrCviow month been respond®d to r0 rratel <br /> 5. Are tank-top containment suraaps tree of wat�'r,Y;de .�•G:r> ; M T <R , <br /> ,. UST SYSTEM(1;NSPEOTION <br /> brie,and hazardous substance? Note:If the answer to item 4 was"Yas, skip <br /> to item 6.Sumps where an alarm has oa-u red in the past month must be inspected j`a qualified service technician has not resounded to,and <br /> roper addressed the clause cif the 4atctrm 1)oce{tnentatiun ueri t a rppriutg service should be attached to this.aw rt. <br /> Yes NO Yes No <br /> Sum Location: :u Sum Locatipn <br /> Sump Location: HE0,11 <br /> ;� <br /> •' '� ' Sum Location: �;,�•;; <br /> 6. Are srll buckets(containment structures)free of water,debris,and hazardous substance? <br /> Yes No N/A Yes No N/A <br /> Tank I ID- .L2 ar <br /> ._� Tank 4 ID- <br /> Tank 2 ID-Diesel ITank 5 ID- -0 OT <br /> Tank <br /> - <br /> Tank 3 ID-Premium MRTank 61DL _#b <br /> 7. Are under-dispenser containment areas free of water,debris,and hazardous substance? <br /> Yes No N/A Yes Na NIA <br /> Dispenser- I/2 .. Dis neer-9/10 <br /> Disp <br /> enser—3/4 Dispenser-11/12 <br /> r-5/6 I3is ser-13114 <br /> r-7/$ Dis user_ 15116 ' <br /> 8ction is raperly 1�cated within under-die eraser containment. <br /> Yes No NIA Yes No N/A <br /> r-- 1/2 Dispenser-9/10 <br /> -3/4 Dispenser I I/12 <br /> --51iDis nSerI31I4 <br /> �----'7/$ <br /> -7: � .. ,t..,,A:;�.; ; .e..::s<:as.::�:.:.:-.:;� <. 15116 <br /> 9. Monitoring System Certification was completed within the A �:.... <br /> PA,Ir'ERW �INSPECTION Yes No N/A Date Daae <br /> past 12 months? 6/1/2012 <br /> It). Lyne Leak Dctectars were tested/certified within the past]2 months? 6/1/20'i2 <br /> 11- Spill bucket(containment M c e)testing completed within the past I2 months? <br /> I?. Line,q tress testingtom leted within the aired time frame? 611/2012 <br /> . .—� <br /> 13. <br /> Secondary containment tests completed within the requiredire titrr_e frarne? — 6/20 ®72 <br /> 14. Enhanced Leak Detection completed within the required timeframe? <br /> 15. Other re u�ixca testin maintenance was completed within required time frame? ®6 <br /> I)escribe Test/Maintenance:Air Quality List test/mairrtenartce items heltxvv_ <br /> Dbe TestlMaintenance:v/L _ 8/1/2012 <br /> FACILITY EMPLOYEE TRAINING <br /> �1 ! <br /> . Have a11_facility em eReEs received the required on-the-ob trainin w}thin the ast ear? Y No NIA <br /> have all facilit em Io ees hired within the ast 30 das received the required art-the-'ob tra9nlffEa <br /> n-.? <br /> UN-057-1/3 <br />