COMPLIANCE INFO_2009-2015 - Laserfiche WebLink

Home Browse Search

0 0 UNDERGROUND STO GE TANK SYSTEM DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT Facility Name: Lodi Food & Liquor Inspection Date: q_( ( -2, Facility Address: 1225 Lockford Street City: Lodi, CA 95240 Name of Designated UST Operator Conducting Inspection: A4 e International Code Council Certification No.: Expiration Date:r�L ZZ` Signature: Phone: (916) 371-2380 ext. N/A=Not A HCRble Item MONITORING PANEL/ALARM HISTORY Yes No N/A 1. Is the monitoring system powered on and in proper operating mode? V1 ❑ ❑ 2. Is the monitoring system not currently showing any leak alar s? ❑ 3. Is the Alarm History Report/log for the previous month avaih ble,and has it been reviewed by the ❑ ❑ Designated UST Operator? (Attach a cqpy o the alarm histc ry Leeortllog to this ins ection form) 4. Has each alarm for the previous month been res ond to a ro riatel ? 1211 ❑ ❑ UST SYSTEM INS ECTION 5. Are tank-top containment sumps free of water,debris,and ha ardous substance? Note:if the answer to hent 4 ivas "Yes,"skip to item 6.Sumps where an alarm has occurred in the past month must be Inspected If a qualified service technician has not responded to,and properly addressed,the cause o the alarm.Documentation vert in a pro riate service should be attached to this re ort. Ye! No Ye! No Sum Locat' S m Location: Sum Location: € S m Location: ❑ 6. . Ares ill buckets(containment structures)free of water,debri;,and hazardous substance? Yes No N/A Yes No N/A Tank 1 ID—87 1 E3 LEJ IRI nk 4 ID— Tank 2 ID—91 T nk 5 ID— Tank 3 ID—DSL T nk 6 ID— 7. Are under-dispenser containment areas free of water,deb.-is,i nd hazardous substance? Yes No Yes No I N/A Dispenser— 1/2 D s enser— ❑ Dispenser—3/4 D s enser— Dispenser—5/601 EJPD.spenser s enser— El Dispenser—7/8 — El ❑ iu 8. Leak detection is properly located within under-dis epser containment. Yes No VA I Yes No N/A Dispenser— 1/2 U D s enser— ❑ Dispenser—3/4 D s enser— ❑ ❑ Dis enser—5/6 Li I D s enser— ❑ Dispenser—7/8 El D s enser— ❑ ❑ "77 PAPERWORK INSPECTION Yes No N/A Date Done 9. MonitoringSystem Certification was completed within the pa,t 12 months? 11-29-2011 10. Line Leak Detectors were tested/certified within the past 12 nths? 11-29-2011 11. S ill bucket(containment structure)testin com leted within he ast 12 months? 11-29-2011 12. Line tightness testingcompleted within the required time fram ? 13. Secondarycontainment tests completed within the re uired ti a fi-ame? ❑ 2-11-2011 14. Enhanced Leak Detection completed within the re uired time rame? 15. Other required testing/maintenance was completed within re fired time frame? (List to t/maintenance items below.) Describe Test/Maintenance:Air Quality St 27&30 12-22-2011 Describe Test/Maintenance: FACILITY EMPLOYEE TRAINING es No N/A 16. 1 Have all facility employees received the required on-the-job troining within the past ear? ❑ 17. Have all facililZ em to ees hired within the East 30 da s recei ed the required on training.? trainin .? Note: Explain any"No"answers in the"Comments"section on the f (lowing page.Those issues require corrective action from the UST owner/operator. LIN-057-1/2 www.unidocs.org 9/26/05