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0 <br /> Designated.Underground Storage Tank (UST) Operator <br /> Monthly Visual Inspection Checklist <br /> Facility Name: Escalon Mini.Mart Date: August 22,2012 <br /> Facility Address. 1097E Yosemite <br /> City: Escalon,CA Zip Code:95320 <br /> Designated UST Operator Conducting the Inspection: James Flowers with Franzen-Hill Corp. <br /> International Code Council Certificn 4: 8036233-UC Expiration Date: 01/26/13 <br /> Signatur Phone: (559)688-2977 <br /> Y Yes,N No,NA Not Applicable <br /> Item MONITORING PANEL/ALARM HISTORY Y N INA, <br /> M( <br /> I Monitoring system is powered on and in proper operating mode, <br /> N� 11 <br /> ii not currently <br /> report/log <br /> or the <br /> pr' <br /> g f <br /> a r <br /> to _,I It'c) <br /> c previous <br /> month Fu7 <br /> 1 .1 ystc I p X- <br /> 2 Monitoring systcni is not currently showing any alarms or warnings. x <br /> j - 1 <br /> 3 Alarin history report/log for the previous month is available,and has been reviewed by the x <br /> Designated UST Operator. (Attach a copy of the alarm history report/log to this forret if available.) <br /> 11 1 �f <br /> 4 Each alarm 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 I <br /> a - List all tank-top setups where alarms occurred in the past month: premium sump <br /> Alote:Sumps where an alarm has occurred in the past month must be inspected unless a qualified service technician responded to,and <br /> properly addressed,the cause of the alarm.Attach documentation verifying appropriate service to this report. <br /> If'suniii inspection is required,record results in item 6,below. <br /> UST SYSTEM INSPECTION <br /> 6 Tank-top containment sumps are free of water,debris,and hazardous substance. Sensors are located properly, <br /> -11-,Vote: Visual inspection ofsump ps is onl) ere analarm has occurred in thepost month or which there is no service record. <br /> Y Y N <br /> Sump Location: x Sump Location: <br /> Sump Location: Sump Location: <br /> Sump Location: &inp Location: <br /> 7 Spill containment structures are free of water, debris,and hazardous substance. <br /> Y N NA Y N NA <br /> Tank I —Con-tents: 87 grade x Tank 3—Contents:VAPOR BUCKE 7S x <br /> Tank 2—Contents: 91 grade x Tank 4—Contents.- I <br /> 8 Under-dispenser containment areas are free of water,debris,and hazardous substance. Sensors are located properly.. <br /> Y N NA Y N NA <br /> Dispenser 112 x Dispenser 9 10 <br /> Dispenser 3 14 x Dispe37ser 11 12 <br /> Dispenser 5/6 x Dispenser 13 14 <br /> Dispenser 7/8 X Dispenser 15 16 <br /> PAPERWORK INSPECTION Y N WA DATE DONE <br /> 9 Monitoring system certification has been completed within past 12 months. x 1-13-12 <br /> — —i--in <br /> lOqSccotidia�r6y=�coyiL-iiiiiiieiit tests have been completed within the required timeframe. x Pending <br /> ...... repairs <br /> I I Spill containment structure(bucket)testing was completed within the past year. x 1-13-12 <br /> 12 Tank tightness testing was completed within required timeframe. <br /> 13 Line tightness testing was completed within required timeframe. <br /> 14 Other required testing/maintenance was completed within required—timeframe. (List test/maintenance items below) <br /> TestlAfaintenance: <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> ��ad FACILITY EMPLOYEE TRAINING Y N NA <br /> 15 All .!ity employees have received the required on-the-job training within the past year.2-27-12 x <br /> 16 1 All facility employees hired within the past 30 days have received the required on-the-job training. x <br /> Note: Any answer of"N"should be explained in the comment section on the following page,and will require <br /> follow-up action. <br />