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Design Underground Storage T (UA Operatd <br />Monthly Visual insnectinn C".hecklict <br />Facility Name: <br />Facility Address: <br />SAN JOAQUIN GENERAL HOSPITAL <br />500 WEST HOSPITAL ROAD <br />Date: <br />Ci <br />NCH CAMP <br />Zip Code: CA 95231 <br />Designated UST <br />Operator Conducting the Inspection: JESSE BERUMEN <br />Intemationa <br />a Counc' Certification 8014628 -UC <br />Expiration Date: 05/24/2 <br />Si tore <br />Phone: ( 209)367-48011 <br />MW <br />Item t/ MONITORING PANEL / ALARM HISTORY <br />1 Monitoring system is powered on and in proper operating mode. <br />2 Monitoring system is not currently showing any alarms or wamin S. <br />3 Alarm history report/log for the previous month is available, and has been reviewed by the <br />Designated UST Operitor. Attach a copy of the alarm history report/7breportl7bg to thisform if avai <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 qualified service tech <br />properly addressed, the cause of the alarm. Attach documentation verifying appropriate service to this report. <br />If sump 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 <br />Note: Visualins ction o sum s is only required in sumps where an alarm has occurred in the hast month for wi <br />Sump Location: TURBINE SUMP XSum Location: <br />Sum Location: PIPING SUMP X Sum Location: <br />Sum Location: Sum Location: <br />7 Spill containment structures are free of water, debris, and hazardous substance. <br />Y N NA <br />Tank 1 – Contents: FILL BUCKET X Tank 3 – Contents: <br />Tank 2 – Contents. 4x— Tank 4 – Contents: <br />8 Under -dispenser containment areas are free of water, debris, and hazardous substjar <br />Y N I NA <br />Dispenser I / 2 X Dispenser 9 / 10 <br />Dispenser 3 / 4 X Dis enser 11 / 12 <br />Dis enser 516 X Dis enser 13 / 14 <br />Dispenser 7 / 8 X Disenser I5 / 16 <br />PAPERWORK INSPECTION <br />9 Monitoringsystem certification has been completed within past 12 months. <br />10 Secondarycontainment tests have been completed within the required timeframe. <br />11 Spill containment structure (bucket)testingwas completed within the past year. <br />12 Tank ti htness testingwas completed within required timeframe. <br />13 Line fightness tes!jRg was completed within re uired timeframe. SEE COMMENTS <br />14 Other re aired testis /maintenance was co leted within re uired timeframe. <br />Test: 4/2018 <br />Test/Maintenance: <br />Test/Maintenance: <br />FACILITY EMPLOYEE TRAINING <br />15 All facilitTemployees have received the required on-the-job training within the pas1 <br />16 All facili em to ees hired within the 2ast 30 days have received the required onAl <br />Note: Any answer of "N" should be explained in the comment section on the follo ink <br />follow-up action. <br />�:r�fr-��1• <br />Pagel of 2 <br />