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Designaf Underground Storage Tank (UST) Noerator <br /> MOnthly'Visual Inspection Checklist <br /> Facility Name:CANEPA,S CAR WASH NORTH Date:AUGUST 24,2005 <br /> h <br /> Facility Address:6230 PACIFIC AVE <br /> Cl :STOCKTON I State: CA. ZIP Code:95207 <br /> Designated UST Operator Conducting the Inspection: Ron Sanchez <br /> International C d Council Certifi ation#:5248997-UC Expiration Date: December 16th,2006 <br /> Signature: Date:AUGUST 24,2005 <br /> 4 < 1l r <br /> Y=Yes N=No NA= Not A licable <br /> Item Monitoring Pan Alarm History Y N NA <br /> 1. Monitoring system is powered on and in proper operating mode? _-R- <br /> 2. Monitoring system is NOT currently showing any alarms or warnings? X <br /> 3. Alarm history report/log for the previous month is available,and has been reviewed by X <br /> the Designated UST Operator?(Attach a copy of the alarm report/log to this form if <br /> available) <br /> 4. Each alarm for the previous month has been responded to appropriately? X <br /> 5. Sensors located in tank-top containment sumps have NOT alarmed in the past month? X <br /> 5a. List all tank-top sumps where alarms occurred in the past month. <br /> Note:Sumps where an alarm has occurred in the past month must be inspected unless a qualified service technician responded to, <br /> and properly addressed the cause of the alarm.Attach documentation verifying appropriate service to this report.If sump <br /> Inspection Is required,put in item 6. <br /> UST System Inspection <br /> 6. Tank-top containment sumps are free of water,debris,and hazardous substance.Sensors are located properly. <br /> Note:Visual inspection of sumps is only required in sumps where an alarm has occurred in the past month for which there is no <br /> service record. <br /> Y N Y <br /> Sum Location UNLEADED X Sum N <br /> Location PLUS X <br /> Sum Location DEISEL X Sum Location SUPREME X <br /> Sump Location - Sump Location <br /> 7. Spill containment structures are free of water,debris,and hazardous substance? <br /> Y N NA Y N NA <br /> Tank 1.Contents UNLEADED X Tank 3.Contents PLUS X <br /> Tank 2.Contents DEISEL X Tank 4.Contents SUPREME <br /> 8. Under-dispenser containment areas are free of water,debris,&hazardous substance?Sensors are workin properly <br /> Y N NA Y N NA <br /> Dispenser 1&2 X Dis enser 9&10 X <br /> Dis enser 3&4 X Dispenser 11&12 X <br /> Dis enser 5&6 X Dispenser 13&14 X <br /> Dispenser 7&8 X Dispenser 15&16 <br /> Paperwork Inspection Y N NA Date <br /> Done <br /> 9. Monitoring system certification has been completed within past 12 months? 7/05 <br /> X /05 <br /> 10. Secondary containment tests have been completed within required timeframe? X 8/05 <br /> 11. Spill containment structure(bucket)testing was completed in the past year? X 8/05 <br /> 12. Tank tightness testing was completed within required timeframe? X 8/05 <br /> 13. Line tightness testing was completed within required timeframe? X 8/05 <br /> 14. Other required testing/maintenance was completed within required timeframe. (List test/maintenance items below.) <br /> Test Maintenance <br /> Test Maintenance <br /> Test Maintenance <br /> Facility Employee Training Y N NA Date <br /> 15. Ali employees have received the required on the job training within the past year? Y Done <br /> 8/05 <br /> 16. All employees hired within 30 days have received the required on the job X <br /> Note:Any answer of"N"should be explained in the co <br /> training? <br /> mment section on the following page,and will require follow-up action. <br /> j <br /> I <br />