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L <br />13 <br />LVED <br />APR 25 2013 <br />Designated Underground Storage Tank (UST) Operator r4005 <br />Monthly Visual Inspection Checklist <br />11rop Shell <br />Date: 01/21/2010 <br />Facility Address: 16500 S. Harland <br />City: Lathrop, CA <br />Zip Code: 95330 <br />Designated UST Operator Conducting the Inspection: Brian Dunahay <br />Monitoring system is powered on and in proper operating mode. <br />International Code Council Certification #: 8021436 -UC <br />Expiration Date: 12 / 06 /2010 <br />—Signature- <br />1 Phone: 888) 700 EPIC <br />Y = Yes, N = No, NA = Not Ap ticabie <br />Item <br />MONITORING PANEL / ALARM HISTORY <br />Y N NA <br />1 <br />Monitoring system is powered on and in proper operating mode. <br />X <br />2 <br />Monitoring system is not currently showing any alarms or warnings. <br />X <br />3 <br />Alarm history report/log for the previous month is available, and has been reviewed by the <br />Designated UST Operator. (Attach a copy of the alarm history report/log to this form i available.) <br />X <br />4 <br />Each alarm for the previous month has been responded to appropriately. <br />X <br />5 <br />Sensors located in tank -top containment sumps have not alarmed in the past month. <br />X <br />5a <br />_ List all tank -top sumps where alarms occurred in the past month: <br />Note: 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 />Lfsume inspection is required, record results in item 6, below. <br />UST SYSTEM INSPECTION <br />6 <br />Tank -top containment sumps are free of water, debris, and hazardous substance. Sensors are located properly. <br />Note: Visual inspection of sunt s is only re uimd in sumps where an alarm has occurred in the past month for which there is no service record <br />Y N <br />Y N <br />Sump Location: <br />Sump Location: <br />Sump Location: <br />Sump Location: <br />Sump Location: <br />Sump Location: <br />7 <br />Spill containment structures are free of water, debris, and hazardous substance. <br />Y NA <br />Y N NA <br />Tank 1— Contents: Reg u I a r Tank 3— Contents: <br />Tank 2 — Contents: Supreme 10 V I Tank 4 — Contents: <br />8 <br />Under -dispenser containment areas are free of water, debris, and hazardous substance. Sensors are located properly. <br />Y N NA <br />Y N INA, <br />Dispenser 1/ 2 X Dispenser 9I 10 <br />Dispenser 3 / 4 X Dispenser 11 / 12 <br />Dispenser S / 6 X Dispenser 13 / 14 <br />Dispenser 7/ 8 X Dispenser 15 16 <br />PAPERWORK INSPECTION Y N NA <br />DATE DONE <br />9 <br />Monitoring system certification has been completed within past 12 months. X <br />11/19/09 <br />10 <br />Secondary containment tests have been completed within the required timeframe. X <br />06/03/08 <br />11 <br />Spill containment structure (bucket) testing was completed within the past year. X <br />11/19/09 <br />12 <br />Tank tightness testing was completed within required timeframe. <br />13 <br />Line tightness testing was completed within required timeframe. <br />14 <br />Other required testing maintenance was completed within required timeframe. (List testlinaintenance items below.) <br />TestlMaintenance: <br />TestlMaintenance: <br />Test/Maintenance: <br />FACILITY EMPLOYEE TRAINING <br />Y I N INA <br />15 <br />All facility employees have received the required on-the-job training within the past year. <br />x <br />16 <br />All facility employees hired within the past 30 days have received the required on-the-job training. <br />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 />M <br />