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r •--designated Underground Storage Tank (UST) Operator <br />Monthly Visual Inspection Checklist <br />Facility Name: Lathrop Shell <br />I Date: 5/28/10 <br />Facility Address: 16500 S. Harlan <br />City: LathropZi <br />Code: <br />Desi ted UST Operator Conducting the Inspection: Steve Zwahlen with Franzen -Hill Corp. <br />International Code Council Certification #:4341047029 <br />Expiration Date: 03 /31 /2012 <br />Signature: 5. <br />Phone: ( 559 ) 688-2977 <br />l Y = Yes, N = No, NA = Not Applicab <br />Item MONITORING PANEL / ALARM HISTORY I Y I N I NA <br />I <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/logreport1log to thisform if 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: T2 <br />OverFill <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 />If sum 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 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 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 I N INA I Y N NA <br />Tank 1 — Contents: Premium X Tank 3 — Contents: <br />Tank 2 — Contents: Regular 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 Y N NA <br />Dispenser 1/ 2 X Dispenser 9 / 10 <br />Dispenser 3 / 4 X Dispenser 11 / 12 <br />Dispenser 5 / 6 X Dispenser 13 / 14 <br />els enser i i o JA I I I Uts enser 1 J/ 16 <br />PAPERWORK INSPECTION Y N NA DATE DONE <br />9 Monitorin system certification has been completed within past 12 months. X 10/7/09 ' <br />10 Secon containment tests have been com leted within the re wired timeframe. X <br />I 1 Spill containment structure(bucket) testing was completed within the past year. X 10/7/09 i <br />Tank tightness testing was completed within required timeframe. <br />E1314 <br />Line tightness testing was com leted within re uired timeframe. <br />Other required testing/maintenance was completed within required timeframe. (List test/maintenance items below.) <br />TestlMaintenance: <br />FACILITY EMPLOYEE TRAINING Y I N INA <br />15 1 All fac-ility employees have received therequired on-the-job training within the past year. X <br />16 All facili 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 />Pagel of 2 September 2004 <br />