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h <br /> 3 <br /> Designated Undergmnd Storage Tank(UM Operator <br /> Monthly Visual Inspection Checklist <br /> Facility Name:C.ANEPA'S C.AR WASH NORTH Date:JULY 20i Ot9:t—� <br /> radii Address:62�lt .AVE <br /> City;S1 R N .___ State:CA_ � ZIP Code:95207 <br /> Desi at UST rotor Conducting the Inspection; S& 2 <br /> International_ Coundl Cestui �:524099997-UC E tratlean Date: miler t6"',TOQb <br /> Sigrtattxe: Data:JULY 20,21005 <br /> Y=Yes N=No NA-1 ot licabk <br /> r2, <br /> em 1tt�ring Panel/Alarm Histoly Y N NA <br /> 1. Mtmttorl system ispowered on and In pr+per optratft soder X <br /> Monitorina system is NOT airrenvy showing any alarms or wamings? x <br /> 3, Alarm history report/log for the previous month Is avapablt,and has been reviewed by X <br /> the Detignated UST Operator?(Attach a cc+py of the alarm report/log to this form if <br /> evailabie X <br /> 4. Each aleri-t for the previous month has been responded to apprapriataty? <br /> S. Sensors located in tank-top containment sumps have NC7i alarmed in rite past month? X <br /> 56. Ust all tank-top sumps where alarms occurntd In the past month. <br /> Not Surmps whem an alarm has occurred in the Hast mordh must be inspea44 untess a qualMad servicetrx Aiden responded to, <br /> i and properly addressed the emu"of the alarm.Atta.h documentation ceryls appropriate service to this report.If ramp <br /> ins �n it trrqukrcd put l s ittttt S <br /> VST System In on <br /> 6. Tank-top containment sumps are free of water,debris.and hazardous substance.Sansors are located properly, <br /> ' <br /> mote;Visual inspedian of sumps is only requlrad in sumps where an alarm has occurred to the part mpsath for which there is no <br /> Y NY9 <br /> Sum Location UN ADED_ x Sum Loation S x <br /> Sum Location DEISFI X Sum Location SUP EME x <br /> Sump Location I WmR Location <br /> 1. ill kxsntainrnent structures are free of water,dtbris,*nd hazardous substance? <br /> _ I Y I td I NA Y N _N <br /> Tank i.Contents UNLEADED X Tenk 3.Contents PLUS X <br /> Tank 2.Contents D€tSEt X Tank 4.Contents SUPREME X <br /> 8. Under•4(gonser containment areas are freer of water,debris,&haaar s st"ane e?Sensors are workin .2 r <br /> Y I N NA Y N NA <br /> Dispenser 1&2 x Dispenser 9&t x <br /> Dispenser 3&4 _ x Dispenser 116.12 x <br /> X is tnser 13&14 _ x <br /> Dispenser 7&8 x Dispenser 15&16 <br /> _ — <br /> Paperwork1 �Gf'toit Y N NA Date <br /> Done <br /> Manhoting system certification hat been ccxnpleted within past 13 months? X 7/05 <br /> 10. Secondary containment tests have been completed within mired timeframe? 5/03 <br /> 11, Spill'caiitainment etnxture(bucket)testing was completed in the past ytart llas <br /> 12.. Tank tightmo testing was eompksted wkhln req ufred tWWrantei S/03 <br /> 13. Line tightness testing was OMP14ted Within required timefron-W 5103 <br /> K. recpdred te.sttng/maintena ce was completed within required timeframe.(Ust Items below,) <br /> Test Maintenance <br /> Test Maintenance <br /> Test Maintenance <br /> Facility Employee Training Y N NA Date <br /> Done <br /> 15. AN employees have received rite required tin the jab training within the pest yw? X 7/05 <br /> t6. R errV&/aw hired within 30 days have ed the required on the jab x 7105 <br /> train) <br /> Now.Arty arouses of"td"should be explained In the con mot stction an the following pew,end wal requirefel -W vroom. <br />