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Designated Underground Storage Tank (UST) Operator <br />Monthly Visual Inspection Checklist <br />Facility Name: Lathrop Shell <br />Date: 7/29/10 <br />Facility Address: 16500 Harlan <br />Monitoring system is powered on and in proper operating mode. <br />City: Lathrop <br />2ip Code: 95330 <br />Designated UST Operator Conducting the Inspection: <br />Steve Zwahlen with Franzen -Hill Corp. <br />International Code Council Cert cation #:4341047029 <br />Expiration Date: 5 /1 /12 <br />, _) <br />Signature: S -t-, - <br />Phone: ( 559 ) 688-2977 <br />V = Yes, N = No, NA = Not Applicable <br />Item MONITORING PANEL / ALARM HISTORY Y N NA <br />1 <br />Monitoring system is powered on and in proper operating mode. <br />X <br />2 <br />Monitoring stem is not currentl showing LRy 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 2pgator. Attach a copy of the alarm history report1log to thisform if available) <br />x <br />4 <br />Each alarm for the previous month has been TT2nded to appropriately. <br />5 <br />Sensors located in !nk-top containment sumps have not alarmed m the past month. <br />X <br />5a <br />_ List all tank -top sumps where alarms occurred in thepast month: <br />A, -7 0#\,4 V. cl@(--�- <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 verging appropriate service to this report. <br />1 i ction is re uired 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 o sums is only required in sumps where an alarm has occurred in the past month or which there is no service record <br />Y I 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 N NA I Y N NA <br />Tank 1— Contents: 91 UNLEADED X Tank 3 — Contents: <br />Tank 2 — Contents: 87 UNLEADED X Tank 4 — Contents: <br />8 <br />Under -dispenser containment areas are free of water, debris, and hazardous substance. Sensors are located l . <br />-)rope <br />Y N NA Y N NA <br />Dispenser 1/ 2 X Dispenser 9 / 10 <br />Dis eraser 3 / 4 X Dispenser 11 / 12 <br />Dispenser 516 X Dispenser 13 / 14 <br />Dispenser 718 X Dispenser 15 / 16 EI <br />x <br />PAPERWORK INSPECTION <br />Y <br />N NA DATE DONE <br />9 Monitorings stem certification has been completed within past 12 months. <br />XJ <br />V4,q 4, <br />10 Secondary containment tests have been completed within the required timeframe. <br />t aN t�TIC <br />NO <br />RECORDS <br />H Spill containment structure (bucket) testing was completed within the past year. <br />X <br />/y' rt .-10iwo-9�- /r <br />12 Tank tightness testing was completed within required timeframe. <br />13 Line tightness testing was completed within required timeframe. <br />14 Other required testin maintenance was completed within required timeframe. (List test/maintenance items below. <br />TestlMaintenance: <br />Test/Maintenance: <br />Test/Maintenance: <br />FACILITY EMPLOYEE TRAINING Y N NA <br />15 All facility employees have received the required on-the-job training within the past year. X <br />16 All facilt em to ees 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 />Pagel of 2 September 2004 <br />