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• <br />01/24/2008 20:48 FAX <br />I <br />Name: Ripon Shell <br />Address: 341 W Main <br />Designated Underground Storage Tank (UST) Operator <br />Heathly 'Visual Ins ction Checklist <br />Date: 1 o `7 <br />Zi Code: <br />� <br />�. tion: Lori Freshour <br />tification #: ; 220353 - UC E. iration Date: 9/17/07 <br />Phone: (916)826-1576 <br />Item <br />M <br />1 <br />Monitorin systrm is powered on arid in Pr <br />2 <br />tVlonitorin systcm is nut Currv`ntly sbowin a <br />3 <br />rUAM history reputt , log for the previous m <br />Qrrach a copy, othe alarm hrWO re ort.' IG <br />4 <br />EaCh alamt for the cviou% month ban been r <br />5 <br />scrams locand in the tank -top eontainnxrra su <br />5a <br />List all rank -top sumps where alarms OCCra7 <br />,Vote- Sumps where an alarm has ocmtrrrd in <br />properly addressed, the cof the alarm. <br />Iar.sr <br />sum inspection is required, record road« <br />6 1 Tank -top <br />[a 003 <br />NITORIING PANEL z IPM HISTORY Y N NA <br />operating nv>de <br />r 81ffitnn or warniO <br />4h is available, and Itas been reviewed by %h4 Designated U. T Operator. <br />!o lhlsform i available) <br />nded to 2empriatcly. <br />n % have not alarmed in d month <br />1 m the past month: <br />14!past month tmisrhe Inspected unlass a quaUfled service technician re,+ponded to, and <br />ach documentation rrifying appropriate service io this report. <br />V1 <br />straps are free of vie ter, <br />imps is SUI required in : u nes <br />t Location. <br />;ontainment structures are free of wab)r. c <br />1- Contents IA Iq (,- <br />2 - Contents P 1 <br />areas are free of water <br />7/8 <br />A <br />substance. Sensors are properly located <br />in the past month for which there is no service record <br />P Location: <br />— <br />T- - Conterds <br />4 - Contents <br />Y N NA Y N NA <br />Dispenser 9 / 10 N <br />Dispenser 11 / 12 <br />Di user <br />12113 t=a <br />Ql I Dispenser 14 / 15 _ <br />PAPERWORK INSPECTION - Y N NA DATE DONE <br />9 Monitonn s stem certification has been co ed within the past 12 months. } - <br />10 Secaidary Containment tests have been cceipleted within the Mired fimeframe. D <br />11 Spill containment structurebucket testin I +etas oompkW within the past year. <br />12 Tank tightness testing was cornpleted within.Leg2fired timeframe. <br />13 Line fi htrmw testi waseted with n, fired timeframe. F N <br />14 Other required testing maintenance was ct)j 71pleted within required timeframe. List test/ maintenance items below <br />Test/Maintenance: <br />Test/Maintenance,- <br />Test / <br />aintenance,Test/ Maintenance: _ <br />FACILITY EMPLOYEE TRAINING Y N NA <br />15 All facifitf employees have received the re,]1jired on-the-job training within the past year. <br />16 All facili( empemployees hired within the ast 3) day have received the required on-the-job training N <br />Note: Any answer of "N' should be explained in tht comment section on the following page, and will require follow-up action. <br />Comments:_ t,. 1° i=t f= - - -`2T'e _ -Z O`-1 e <R 131 <br />i <br />Follow-up action required: _ <br />i Date: <br />Oester ! Manager Signature* _ <br />