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f <br /> Designate Underground Storage Tank (UST) Wator <br /> Monthly Visual Inspection Checklist <br /> Facility Name:CANEPA'S CAR WASH NORTH Date: AUG.11,2005 <br /> Facility Address:6230 PACIFIC AVE. <br /> City:STOCKTON I State:CA. ZIP Code:95207 <br /> Designated U Operator Conducting the Inspection: Ron Sanchez <br /> Internation ode Council Cert tion#j. 248997-UC Expiration ate: December 16th, 2006 <br /> Signatur Date: <br /> (Y=Yes N= No NA=Not A licable <br /> Item Monitorin nel /Alarm History Y N I NA <br /> 1. Monitoring system is powered on and in proper operating mode? X <br /> =3. Alarm <br /> ring system is NOT currently showing any alarms or warnings? X <br /> history report/log for the previous month is available,and has been reviewed by Xsignated UST Operator?(Attach a copy of the alarm report/log to this form if <br /> le) <br /> arm 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 /> 1-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. Y N <br /> Y N <br /> ffl <br /> ation UNLEADED X Sum Location DEISEL X <br /> ation PLUS X Sum Location SUPREME X <br /> ation Sum Location <br /> inment structures are free of water,debris,and hazardous substance? <br /> Y N NA Y N NA <br /> ontents UNLEADED X Tank 3.Contents PLUS X <br /> ontentsDEISEL X Tank 4.Contents SUPREME <br /> X <br /> s enser containment areas are free of water,debris,&hazardous substance?Sensors are workin ro erl <br /> Y N NA Y N NA <br /> Dispenser 1&2 X Dispenser 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? X 7/05 <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 /> Done <br /> 15. All employees have received the required on the job training within the past year? Y 8/05 <br /> 16. All employees hired within 30 days have received the required on the job X <br /> trainin ? I I r <br />