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Facility Name: <br />Facility Address: <br />Ci <br />Desimated UST <br />Designated Rderground Storage Tank (UST) Orator <br />Monthly VisualInspection <br />1 i1 12W - <br />goo <br />. ' - <br />go 1ROAD f <br />FRENCH CAW I Zip Code: CA 95231 <br />ator Conductin the Inspection: JESSE BERUMEN <br />,un it Certification 8014628 -UC Expiration Date: 06/06/2016 <br />Phone: ( 209 3674800 <br />Y=Yes.N= <br />Item MONITORING PANEL / ALARM HISTORY <br />1 Monitoring, s stem is powered on and in proper operating mode. <br />2 Monitoringsystem is not currentlyshowinganalarms or warms s. <br />3 Alarm history report/log for the previous month is available, and has been reviewed by the <br />Designated UST Operator. '(Attach a copy o the alarm history report/logrepoqjog to thisform if available. <br />F5a4Each alarm for the revious month has been res onded to a ro riatel . <br />Sensors located in tank -to containment sum s have not alarmed in the ast month. <br />- List all tank -top sumps where alarms occurred in the past month: <br />6 <br />7 <br />8 <br />Note: Sumps where an alarm has occurred in the past month must be inspected unless a quaked service technician rest <br />properly addressed the cause of the alarm. Attach documentation verging appropriate service to this report. <br />—I If sump inspection is required, record results in item 6, below. <br />UST SYSTEM INSPECTION <br />ink -top containment sumps are free of water, debris, and hazardous substance. Sensors are located <br />Note: Visual inspection of sumps is on re uired in sum s where an alarm has occurred in the past month for which there <br />Y N <br />Sump Location: TURBINE SLJMP X <br />Sump Location: PIPING SUMP X <br />Sump Location: <br />Spill containment structures are free of wate <br />Y <br />Tank 1 — Contents: FILL BUCKEI—t X <br />Tank 2 — Contents: <br />Under -dispenser containment areas are free <br />Y <br />Dispenser 1/ 2 <br />Dispenser 3 / 4 <br />Dis eraser S / 6 <br />Disnenser 7 / 8 <br />M <br />�?j',}°S Sump Location:_ <br />nSump <br />Sum Location:Location: <br />ebris, and hazardous substance. <br />N INAI <br />Tank 3 —Contents: <br />X I Tank 4 —Contents: <br />debris. and hazardous substance. Sensors are <br />X <br />a <br />9 <br />Monitoring system certification has been com ietea wimm Past I tnumhs. <br />r <br />03/24/2015 <br />10 <br />Secondary containment tests have been completed within the required timeframe. <br />X <br />11 <br />Spill containment structure(bucket) testing was completed within the past year. <br />X <br />08/17/2015 <br />12 <br />was completed within required timefre. <br />Tank ti mess testis am <br />X <br />------------ <br />13 <br />Line tightness testing was completed within required timeframe. SEE COMMENTS <br />I X 1 <br />08/22/2014 <br />14 <br />Other required testis maintenance was completed within required timeframe. <br />'777 ° „ /2018 <br />Test: Tari " ua.'� n <br />X <br />03/24/2015 <br />TesdMaintenance: <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 ast <br />Rn-thqjob <br />'ear. <br />X <br />16 <br />All facilq em to ees hired within the past 30 da s have received the required <br />train,' . <br />Note: <br />Any answer of "N" should be explained in the comment section on the following <br />page, and will require <br />follow-up action. 7 <br />E ..° <br />Page 1 of 2 -November 2004 <br />