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19 • 0 �__._arty wCYL' TANK SYSTEM RATOR MONTHLY INSPECTION REPOR. acilihName:r Inspection Date: Facility Address: 0 0 ycbCity:f C s Name of Designated UST Operator Conducting* Inspection: p Guadalupe Sanchez International Code Council Certification No.: 5250451 _UC Expiration Date: 2/9/2015 Signature:-�-i€-Phone: (209) 804-9363 ext. tram MONITORING PANEL /ALARM HISTORY nrA = Yes tiot Appileable No ' N/A T Yes ❑ I. I Is'tiie monitoring stitst. em potsterd pn and in Pro er operating mode? 'tank 2 ID � ❑ ❑ 2. is the monitorine systent not currentt 'showing any leak alarms? _ _ � 9 -� j ❑❑— ❑❑ ❑ � ❑ 3. Ishe Alarm Histor}° Report/iog for the previous month available; and has it been reviewed by the ❑ ❑ 10. Line Leak Detectors were tested/cc,rtrtied within the past 12 months?_ 1 Desienatad LJST O erator? ;Attach a co o the alanrr history re orillog to this inseection form.} and hazardous substance? a) a. Ilas each alarm for the revious month been res onded to a propriately? -- Yes No N/A ❑ .❑ ❑ Yes No N/A � Dispenser - 1;2 UST SYSTEM INSPECTION M_ ❑ ❑ Disunser - 9'10 - 5. = _ Are tank -top containment sumps free of water, debris, and hazardous substance? _ Yes No� °NIA Dispenser - 314 ito .dote: 0he ansner to Item 6. Sumps w here an alarnt has occurred in the past month must be inspected if a aualJed service technician has hernia was Yes' skip not responded to and Dis enser -- 11 112 properly addressed the cause of the alarm. Documentation vert in a ro riate service should be attached to this report. - ❑ ❑ Dis' enser-5t6�__. Yes No Yes Na ❑ Dispenser - 13/14 �— ❑ Sum Location: - _ ❑ ❑ SumLocation Ll❑ l -t-+ C Sum Location: ❑ ' Sum Location _ 6. i Are spill buckets (containment structures) free of water, debris and hazardous substance`' ❑ ❑ j a) ' Tank I ID - g C O U CU N -- i g Yes No El N/A_ F1 Tank 4 1D-- T Yes ❑ No El N/A El 'tank 2 ID � ❑ ❑ Tank 5 ID -07 _ 9 -� j ❑❑— ❑❑ z Tank. 3 ID - ❑ ❑ ❑ Tank 6 ID - - �� 10. Line Leak Detectors were tested/cc,rtrtied within the past 12 months?_ ❑ 7, Are under-dis enser containment areas free of water, debris, and hazardous substance? l2. l rue ti Li ss test%p G m feted within the re uired time frame? ❑ , -- Yes No N/A ❑ .❑ ❑ Yes No N/A Dispenser - 1;2 ❑ ❑ Disunser - 9'10 - -- - ❑ _ Yes No� °NIA Dispenser - 314 ® ❑ [] Dis enser -- 11 112 ❑ ❑ ❑ Dis' enser-5t6�__. �� = s m�av unidocxu ❑ ❑ Dispenser - 13/14 �— ❑ ❑ ❑ l Dispenser - 7B ET❑ Dis enser 15! l b - - — — ❑ [] i ❑ Leak;,detection is ro erl located within under-dis enser containment. -- O eV Yes No N/A -- Yes No NIA V N Dis enser- 2t2 � ❑ Dispenser -9/10_ ❑ ❑ � _ _❑ Di&;enser ria ❑ ❑ Dis enser-- 1 Ut2 ❑ - t U O ❑ Dis' enser-- 13/14 ---- 9 -� j ❑❑— ❑❑ z ❑ ❑ Dispenser - 15/16 w_ I _ PAPERWORK INSPECTION `9. Mcinitorin stem Certification was completed within the past 12 months? N/A�_ one' ❑ 10. Line Leak Detectors were tested/cc,rtrtied within the past 12 months?_ [� ❑moi-�_2Sr ! 7 -- )IL bucket containment structure) testing completed within the ast 12 months? ❑ ❑ z i -t ? — -❑ l2. l rue ti Li ss test%p G m feted within the re uired time frame? ❑ , i 3. Sewn ,containment tests coin leted within there aired tithe frame? ❑ ❑ - t,!i. ancr ,, eak Detection op feted within the required time frame? ❑ .❑ ❑ _ 305 ' haai#tstance was completed withinrequired time flame? (List test/maintenance' item,, helotV.) : Descrif a TestlivfaintenviEl ? es�ntenazace:El ED]EE ,itrwC TY KMPLOYEE TRAINING _ Yes No� °NIA G e411, faciltenn to ets reeeiit ifie required on thej'j iraininLwithin the Bast year? ❑ - ;i7: have+i Dili to els fiired uyithin the East 30 days received the re uired on the='ob trainin �,`? )eiote; explain any' No" an`sWe s, rl the `` otnmerW section on the following page. Those issues require corrective action froth ``� �IS� �wnerto�erator. �� = s m�av unidocxu :. it: i y�