Laserfiche WebLink
11tesignate4nderground Storage Tank (UST*er,* <br />Monthly Visual Insvection Checklist <br />Facility Name: <br />Facility Address: <br />SAN JOAQUIN GENERAL HOSPITAL <br />500 WEST HOSPITAL ROAD <br />Date: 771 <br />-City: <br />FRENCH CAMP <br />Zip Code: CA 95231 <br />Designated UST Operator <br />Conducting the Inspection: JESSE BERUMEN <br />International de Counci ertification 8014628 -UC <br />Expiration Date: 05/24 <br />Signature/ <br />X <br />Phone: ( 209 ) 367-4800 <br />Y= <br />Item MONITORING PANEL / ALARM HISTORY <br />1 MonitoKin& system is powered on and in proper operating mode. <br />2 Monitoring system is not currently showing any alarms or warnings. <br />3 Alarm history report/log for the previous month is available, and has been reviewed by the 2 <br />Designated UST Operatof. Attach a copy of the alarm history report/logreport1log to this form i ava <br />4 Each alarm for the previous month has been responded to appropriately. <br />5 Sensors located in tank -top containment sumps have not alarmed in the past month. <br />5a _ 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 quaked service techr <br />properly addressed, the cause of the alarm. Attach documentation verifying appropriate service to this report. <br />I sum inspection is re uired, record results in item 6, below. <br />UST SYSTEM INSPECTION <br />6 1 Tank -top containment sumps are free of water, debris, and hazardous substance. Sensors are 1 <br />Note: Visual inspection of sumps is only required in sumps where an alarm has occurred in the past month for whh <br />ilj-{er14 <br />t,d — 1 J �� 77 .ei•• f �i1 �``,i <br />e .1 <br />Y N 1 1, <br />Sump Location: TURBINE SUMP X Sump Location: <br />Sump Location: PIPING SUMP X Sump Location: <br />Sump Location: Sump Location: <br />7 Spill containment structures are free of water, debris, and hazardous substance. <br />Y N NA Y N NA <br />Tank 1 - Contents: FILL BUCKET X Tank 3 - Contents: X <br />Tank 2 - Contents: X Tank 4 - Contents: X <br />8 Under-dis enser containment areas are free of water, debris, and hazardous substan6e. Sensors are located 3roperly. <br />Page 1 of 2 November ?084 <br />Y I N I NA <br />Y N NA <br />Dispenser 1 / 2 X Dispenser 9110 <br />X <br />Dis enser 3 / 4 X Dis enser 11 / 12 <br />X <br />Dis enser 5 / 6 X Dis enser 13 / 14 <br />X <br />Dis enser 7 / 8 X Dis enser 15 / 16 <br />PAPERWORK INSPECTION <br />N NA <br />X <br />DATE DONE <br />9 <br />Monitoringsystem certification has been completed within past 12 months. <br />7-- <br />08/25/2016 <br />10 <br />Secondarycontainment tests have been completed within the required timeframe. <br />03/24/2015 <br />11 <br />Spill containment structure (bucket) testin was completed within the past year. <br />08/25/2016 <br />12 <br />Tank tightness testing was completed within required timeframe. <br />X <br />----- --- _-- <br />13 <br />Line tightness testing was completed within required timeframe. SEE COMMENTS <br />X <br />08/27/2015- <br />14 <br />Other required testin maintenance was com leted within re wired timeframe. <br />Test/Maintenance: <br />03/24/2015 <br />Test/Maintenance: <br />FACILITY EMPLOYEE TRAINING <br />—facility <br />Y N NA <br />15 <br />All employees have received the required on-the-job training within the past <br />year. <br />X <br />16 All facility em to ees hired within the past 30 days have received the required onj. <br />Note: Any answer of "N" should be explained in the comment section on the followi <br />follow-up action. <br />'ob traitrin . <br />page, "And will require <br />iJ <br />Page 1 of 2 November ?084 <br />