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V C) <br /> N <br /> r--� <br /> UNDERGROUND STORAGE TANK SYSTEM 0 NT <br /> ESIGN'ATED UST OPERATOR MONTHLY INSPECTION REPORT <br /> --- ¢' o <br /> ,� dame A inspection Date: 3 - 3 1 - -Z <br /> ('ill F JCC-^ 'e Cin: k ell�­­eCh (�6 <br /> o:Designated UST Operator Conducting Inspection: Guadalupe Sanchez p <br /> Code Ccnmci1 Certifwwic,r No.: 5250451-UC E�ptrauon Date: 2/9/2015 N O <br /> 604-9363 est- a_ <br /> pkm MONITORING PANEL:ALARM HISTORY __ les No \,A C4 <br /> ? Is the monitoring system %h ered on and in proper operarina mode'? __ .. •� <br /> Is the monitorine s stem not cwrenth sho%.ir._am leak alarms" <br /> FS the Alarm History Report tog for the previous month available.and has it been reviewed b%the ❑ J <br /> .ry t7esignated UST razor tAuach a LTI,of the alarm history re ort to to dric inc ecrion dorm-t N <br /> 4.- Has each alarm for the previous month been responded to appropriately? f 1 <br /> UST SYSTEM INSPECTION to <br /> �- <br /> � <br /> Are tank-tap containment sumps free of water.debris_and hazardous substance? :s'az:!f doe anrxer ro tram t vas .hes-sd,� �,,, <br /> to hem 5 5; p-,where an alarm has Pr the tus:m.;nti.mw—r Ie:r„rwcred J a giatrfjed sentrechraran has n:.r rsq,?,ded ro ask: 0 <br /> 0 rtl, rfr.niirz -a rJr as sr o thea/m+►i Docvrnrnrn:ua si.rh me" ^re.rrarr;erne;hw1J b mttxhed to rhu re <br /> Yes Na t— Yes No : <br /> 0 <br /> Sump Location: I � ❑ t Sum Location: p <br /> W �_ump Location: ElLJSum ❑ (J 'ILocation: - <br /> 6. Are spill buckets(containment structures)free of tsater.debris,and hazardous substance? <br /> Yes No NLA r Yes No 11/A p <br /> ( Taa 11D- I6 ❑ ❑ Tank 4 ID- b <br /> !� Tank 2 ID- ; ❑ Tank 5 ID- ❑ <br /> Tank 3 ID- t ❑ ❑ ( Tank 61D- <br /> !� i Are and:r-dispenser containment areas free of water,debris,and hazardous substance? <br /> Yes, No N/A :es' No N?A <br /> Dispenser- I D ispenser-9110 <br /> Dispenser- 3 4 ❑ Dispenser- 11;12 iCd <br /> Dis nser-5'6 ❑ I ❑ Dispenser- 13+14 ❑ <br /> Dispenser- 7 S ❑ ❑ <br /> Dispenser-15%16 r— O <br /> 8 Leak detection is properly located within under ser containment <br /> Yes.I No i(NIA 1 es \o NIA 0 <br /> Dispensed 1 2 ❑ ! ❑ Dis penser-9,110 ❑ i �, <br /> D;> enser -- - Dispenser-- 11/12 <br /> O <br /> l 6 penser . ❑ I Dispenser- 1314 <br /> 1):-.penser=7.k <br /> ❑ , Dispenser- 1516 <br /> PAPERWORK INSPECTION Yes No N A Date Bone <br /> 9. Monitorink S}stem Certification was completed within the past 12 months? EJ ❑ <br /> 10. Line Leak Detectors were tested certified within the past 12 months? ` <br /> 1 i^ ' S tp�ll bucket(containment structure)testing completed within the past 12 months? <br /> 12 Line ti rhtnesS testing completed within the required time frame? 1 ❑ <br /> 13. 'Secondan containment tests completed within the required time frame? El El <br /> 14. Enhanced LeakDetec tion completed within the required time frame? Li NJO <br /> 15. Other required test in r'maintenance was completed within required time frame? (List restlmaintenance items h tlox) <br /> V Describe Test/Maintenance: <br /> ? Describe Test/Maintenance: <br /> —--------._—_---_--- �yy <br /> �i ---✓,-- FACILITY EMPLOYEE TRAINING YYes No N/A v <br /> T Have all facility empl� s received the required on-mob training within the past 'eat? <br /> 7. Iia-.C all 1"4cility em loyeo hired within the past 30 da s received the required on-the-job trainin ' <br /> : Explain any"Nd'answers in the"Comments"section on the following page.Those issues require corrective action from <br /> 0 the UST ownerioperator. <br /> U In "wA.unidooLorg <br /> Qt _ a <br />