Laserfiche WebLink
Designate nderground Storage T (USAPerator u: <br />Monthlv Visual Inspection Checklist <br />Facility Name: <br />SAN JOAQUIN GENERAL HOSPITAL <br />Date: /01 <br />Facility Address: <br />500 WEST HOSPITAL ROAD <br />Monitoring system certification has been completed within past 12 months. <br />City: <br />FRENCH CAMP <br />Zip Code: CA 95231 <br />Designated UST <br />Operator onducting the Inspection: JESSE BERUMEN <br />InternatioLm <br />a Council Certification 8014628 -UC <br />Ex iration Date: 05/24/2018 <br />Si tune: <br />Spill containment structures are free of water, debris, and hazardous substance. <br />Phone:( 209 ) 3674800 <br />H H 1\ 1\V 1\A - 1\V6 VCAV{C <br />Item MONITORING PANEL / ALARM HISTORY Y I N NA <br />mmmmmmmmmmmom <br />1 Monitoring system is powered on and in pro er operating mode. X <br />2 Monitoring system is not currently showing any alarms or warnings. X <br />3 Alarm history report/log for the previous month is available, and has been reviewed by the X <br />Designated UST Operat6r. Attach a copy of the alarm history report/logrgportfiog to thisform if available. <br />4 Each alarm for the previous month has been responded to a ro riatel . X <br />5 Sensors located in tank -top containment sumps have not alarmed in the past month. X <br />Pa - 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 />Ifsump inspection is required, record results in item 6, below. <br />1113 CV6.1 V D1 <br />6 <br />Tank -top containment sumps are free of water, debris, and hazardous substance. Sensors are located properly. <br />Note: Visual inspection osum s is only requi in sums where an alarm has occurred in the ast month or which there is no service record. <br />Y I iN INA1 <br />Y N <br />Y N. <br />Monitoring system certification has been completed within past 12 months. <br />Sump Location: TURBINE SUMP XSump <br />Location: <br />10 <br />Sump Location: PIPING SUMP X <br />Sum Location: <br />03/24/2015 <br />Sum Location: ESump <br />Location: <br />7 <br />Spill containment structures are free of water, debris, and hazardous substance. <br />12 <br />Y I N INA Y N NA <br />X <br />Tank 1 — Contents: FILL BUCKET X Tank 3 — Contents: X <br />13 <br />Tank 2 — Contents: X Tank 4 — Contents: X <br />8 <br />Under -dispenser containment areas are free of water, debris, and hazardous substatice. Sensors are located ro erl . <br />14 <br />Y N INA Y N INA <br />Dispenser 1 / 2 X Dispenser 9 / 10 X <br />Dispenser 3 / 4 X Dispenser 11 / 12 X <br />X <br />Drs enser 5 / 6 X Dispenser 13 / 14 X <br />Drs eraser 7 / 8 X Drs eraser 15 / 16 X <br />Page 1 of 2 November 2004 <br />PAPERWORK INSPEC;TWIN <br />Y I iN INA1 <br />UAIMUVINM <br />9 <br />Monitoring system certification has been completed within past 12 months. <br />X <br />08/17/2015 <br />10 <br />Secondary containment tests have been completed within the required timeframe. <br />X <br />03/24/2015 <br />11 <br />Spill containment structure(bucket) testing was completed within the past year. <br />X <br />08/17/2015 <br />12 <br />Tank tightness testing was completed within required timeframe. <br />X <br />------------- <br />13 <br />Line tightness testing was completed within re uired timeframe. SEE COMMENTS <br />X <br />08/22/2014 <br />14 <br />ted within required timeframe. <br />Other re uiffiffigaga <br />Test: 4/2018 <br />Test/Maintenance: <br />X <br />03/24/2015 <br />Test/Maintenance: <br />FACILITY EMPLOYEE TRAINING <br />Y N NA <br />15 <br />All facility employees have received the required on-the-job training within the past <br />year. <br />X <br />16 <br />Note: <br />All facili em to ees hired within the ast 30 da have received the uired o �tle-`oli ir0inin .', X <br />Any answer of "N" should be explained in the comment section on the followi' g page, and will require <br />follow-up action. <br />Page 1 of 2 November 2004 <br />