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® FROM FAX NO. Ahn. 19 2013 04:30PM P5 <br /> UNDERGROUND TO IGE TANK SYSTEM <br /> ESI AT ST OPERATOR MONTHLY INSPECTION REPORT <br /> Facility Name: $8 Gas&Mart Inspection Date: May 26, 2013 <br /> Facility Address: a, �: Tracy <br /> 51 S W. 41 St. Ci <br /> Name of Designated UST Operator Conducting inspection.: Robert Bamhart <br /> Internatio Code ou " Certification No.: 5252540-UC Expiration nate: <br /> 112$/2014 <br /> ' Signature. � Thane: <br /> (209)604-9336 ext, <br /> Item MONITORING PANEL/AL HISTORYE,i <br /> N/A�>Mot A icAble <br /> 1. Is the mong2Eing s stern veered on and in fifes No N/A--I Proper a�aerating made?2. Is the monitori s stem not curr�tly shawin any leak alarms? <br /> 3. Is the Alarm History Report/log for the previous month available,and has it beers reDesi rated UST U. pwitor? (Attach a co��of the aiarm .4. Has each alarm forr thePrevious month been rp 4Jy71 �YVRG ,:.'::.:.:....... ...v,�.:. <br /> `M INSPECTION <br /> 5. Are tank-to containment sumps free of water debris,and hazardous substance? Note:If ti;answer$0 Item 4 seas-Yes,"skip <br /> to Item 6.Sumps when an alarm has omurmd to the past mamth must N inspected if a gkalefred servece techmclan has not responded to,and <br /> r0 r ad+�res3ed*e Cawse of lh�alarm.j]pourr�rydativn_�t fpr rhaie sarViee shpk&1 be aYktChed t4 tht <br /> is re • <br /> Sump LOCation: :y ': Yes Na <br /> Sum T �a S Location" <br /> aCation: Sump Location: <br /> 6. Ares ii!buckets containment structures free of water,debris,and ha2ardons substance? <br /> Yes No N/A Yes No N/A <br /> Tank 3 IIS-Re�ttlar Tank 4 ID- <br /> Tank 2 ID-Diesel Tank 5 ID- <br /> ,__,. "rank 3 ID,�Fremium ,.. Tank 6 iD_ .�" <br /> 7. Arc under-di eraser cantainttrent areas free of water debris,and hazardous substance? <br /> . Yes No N/A <br /> Dis enser-lIa Dis enser-9110 Yes No I N/A <br /> Dispenser--3/4 Dispenser-11/12 <br /> Dis eraser-5/6 ❑ Dis nser-13/14 <br /> Dis eraser-7/8 Q <br /> Dispenser-15116 <br /> 8. Leak detection is Proper°ty i0c4ted within under-dis nser containment <br /> Yes No N/A Yes No NIA <br /> Dis nser-1/2 _ Dis eraser-9110 <br /> Dis nsCr-�-3J4 � Dis eraser.-11/12 <br /> " <br /> Dispenser 516 Dispenser-13/14 - <br /> Dis ser-7/8 � �--� <br /> a , _ Dispei 15/1 <br /> g.ystem CertificaPAPERWORK camgletedEw thi�the past a2¢?� Y >...:.: Done <br /> 9, Monitorin 5 Y� No N/A Date Done <br /> months? 6/1/2012 <br /> 10, Line beak Detectors were testedlcertified within the past 12 months? 6/112012 <br /> 11. Spill bucket(containment structure)testing completed within the past 12 months? ® 6/1!2012 <br /> 12. Line ti mess stating oampleted within the re uq /red time frame? <br /> 13. Seton containment tests cote leted within the required time frame? &/20/2012 <br /> 14. Enhanced Leak Detection completed within the required red tithe frame? <br /> 15. Ower intenanat Aires was co meted within required,time frame`? (List testlmalydvnance items belaw. <br /> Describe Test/Maintcnance:V/L ❑ 8/112012 <br /> ❑ 2/6/21712 <br /> iH'ACILITY EMPLOYEE TRAINING <br /> �- 16. Have all��JJ-ft—er�� io ees received the meed an-the-oh trainin within the t year? Yes No N/A <br /> 17. Have allem 100 <br /> ces hired within the est 30 days received the reQuired on-the-lob training.? <br /> Y.n-new a w <br />