Laserfiche WebLink
WesignateAderground <br />Monthly.l Inspection <br />lity Name: SAN JOAQUIN GENERAL HOSPITAL Date: <br />lity Address: 500 WEST HOSPITAL ROAD <br />FRENCH CAW ip Code: CA 95231 <br />[gnated UST Operator Conducting the Inspection: JESSE BERUMEN <br />mation de Council Certification 8014628 -UC I Expirafion Date: 06 <br />intnrP- / L Ae) _ .. _ __ � I Phone: ( 209)367-481 <br />Item 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 warnings. <br />3 Alarm history report/log for the previous month is available, and has been reviewed by <br />Designated USTerator'. Attach a co o the alarm histo reportllog report/logto thisform a <br />4 Each alarm for the previous month has been responded to ap atel . <br />5 Sensors located in tank -top containment sumps have not alarmed in the ast month. <br />5a List all tank -top sumps where alarms occurred in the past month: <br />FACILITY EMPLOYEE TRAINING Y I N I NA <br />15 All facility employees have received the required on-the-job training within the past year. X <br />16 All faciliy em to ees hired within the past 30 das have received the re uired. =L-' b trainin . <br />Note: Any answer of "N" should be explained in the comment section on the follol" ing page; and will require <br />follow-up action. <br />Page 1 of 2 November0�4 <br />Note: Sumps where an alarm has occurred in the past month must be inspected unless a qualified se <br />properly addressed the cause of the alarm. Attach documentation verging appropriate service to <br />1 = 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. S <br />Note: Visual inspection o sumps is onLy re uired in sumps where an alarm has occurred in the ast <br />Y N <br />Sum Location: INE S X Sum Location: <br />Sum Location: PIPINGS X Sum Location: <br />Sum Location: Sump Location: <br />7 <br />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: x <br />i' <br />Tank 2 — Contents: X Tank 4 — Contents: r <br />8 <br />Under -dispenser containment areas are free of water, debris, and hazardous sub <br />Y N NA <br />Dispenser 1/ 2 X Dispenser 9110 <br />Dispenser 3 / 4 X Dispenser 11 / 12 <br />Dispenser S / 6 X Diseraser 13 / 14 r <br />Dis enser 7 / 8 X Dis eraser 15 / 16 <br />PAPERWORK INSPECTION <br />9 <br />Monitoring system certification has been com leted within past 12 months. <br />10 <br />Secondary containment tests have been completed within the re uired timeframe. <br />X i 1 14/2015 <br />11 <br />Spill containment structure(bucket) testing was com leted within the past year. <br />X 08/17/2015 <br />12 <br />Tank tightness testis was completed within required timeframe. <br />X ----------- <br />13 <br />1 Line tightness testing was completed within required timeframe. SEE COMMENTS <br />X 08/22/2014 <br />14 <br />Other required testin maintenance was completed within required timeframe. <br />Test 9 " ' /2018 <br />X 03/24/2015 <br />Test/Maintenance: <br />Test/Maintenance: <br />FACILITY EMPLOYEE TRAINING Y I N I NA <br />15 All facility employees have received the required on-the-job training within the past year. X <br />16 All faciliy em to ees hired within the past 30 das have received the re uired. =L-' b trainin . <br />Note: Any answer of "N" should be explained in the comment section on the follol" ing page; and will require <br />follow-up action. <br />Page 1 of 2 November0�4 <br />