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U E O SO G T YSTE S ESINAT UST OPERATOR MONTHLY INSPECTION REPORT Facility Name: Kwik Serve Inspection Date: July 29, 2011 Facility Address: 950 W. 11th St City: Tracy Name of Designated UST Operator Conducting Inspection: James Abbott International Code Council Certification No.: 8006067-UC Expiration Date: 3/17/2012 Signature: Phone: 601-4641 ext. N/A=Not Applicable MDesi MONITORING PANEL/ALARM HISTORY YeS NO N/A onitorin system powered on and in ro er o eratin mode? o monitoring s stem not currentl showing an leak alarms? larm History Report/log for the previous month available,and has it been reviewed by the ❑ ted UST Operator? Attach a co o the alarm histo re ort/lo to this ins ection orm.) h alarm for the previous month been responded to appropriately? ❑ ❑ UST SYSTEM INSPECTION 5. Are tank-top containment sumps free of water,debris,and hazardous substance? Note:If the answer to Item 4 was "Yes,"skip to Item 6. Sumps where an alarm has occurred in the past month must be inspected if a quaked service technician has not responded to, and properly addressed the cause o the alarm.Documentation vera ing appropriate service should be attached to this report. Yes No Yes No Sump Location: ❑ ❑ Sjnp Location: Sump Location: ❑ ❑ I Sump Location: ❑ ❑ 6. Ares ill buckets(containment structures)free of water,debris,and hazardous substance? Yes No N/A Yes No N/A Tank 1 ID—Dsl ® Tank 4 ID Tank 2 ID—Prem ® Tank 5 ID ❑ Tank 3 ID—Reg Tank 6 ID'- ❑ ❑ 7. Are under-dispenser containment areas free of water,debris,and hazardous substance? Yes I No I N/A Yes No N/A Dispenser—1/2 Z I ❑ I Dispenser—9/10 ❑ Dispenser—3/4 ® ❑ Dispenser—11/12 ❑ Dispenser—5/6 ❑ Dispenser— 13/14 Dispenser—7/8 ® ❑ Dis enser— 15/16 ❑ 8. Leak detection is properly located within under-dispenser containment. Yes No N/A I Yes No N/A Dispenser—1/2LdN n I Dispenser—9/10 ❑ ❑ Dispenser—3/4 ❑ ❑ Dispenser— 11/12 El ❑ Dispenser—5/6 ® ❑ Dispenser 13/14 ❑ ❑ Dispenser—7/8 ® I ❑ I ❑ I Dispenser—15/16 ❑ 1 ❑ PAPERWORK INSPECTION Yes No N/A Date Done 9. Monitoring System Certification was completed within the past 12 months? ® M F] 9/2/2010 10. Line Leak Detectors were tested/certified within the past 12 months? ❑ El9/2/2010 11. Spill bucket(containment structure)testing completed within the past;12 months? El9/2/2010 12. Line tightness testing completed within the required time frame? ® ❑ ❑ 9/2/2010 13. Secondary containment tests completed within the required time frame? ® ❑ ❑ 5/2/2010 14. Enhanced Leak Detection completed within the required time frame? 0 LJ ❑ 4/27/2010 15. Other re aired testin /in was completed within required time frame? List test/maintenance items below. Describe Test/Maintenance: I ❑ I ❑ Describe Test/Maintenance: I ❑ I U1 ❑ FACILITY EMPLOYEE TRAINING Yes No N/A —` 16. Have all facility employees received therequired on-the job training within the past ear? ® F1 ❑ 17. Have all facili em to ees hired within the past 30 days received the re wired on-the job train. .?