Laserfiche WebLink
i <br />Desi gnatfenderground Storage Tank (USPperator <br />Monthly Visual Inspection ChecVist <br />Facility Name: <br />SAN JOAQUIN GENERAL HOSPITAL <br />Date: <br />Facility Address: <br />500 WEST HOSPITAL ROAD <br />Z Z <br />City: <br />FRENCH CANT <br />Zip Code: CA 95231 <br />Designated UST Operator <br />Conducting the Inspection: JESSE BERUMEN <br />Internatiounde Counc" rtification 8014628 -UC <br />FE—xpiration Date: 06/0 <br />Signature/ <br />�m Location: TURBINE SUMP X Sump Location: <br />I Phone: 209 367-480 <br />Item <br />MONITORING PANEL / ALARM HISTORY <br />Monitoring system is powered on and in proper operating mode. <br />Monitoring system is not currently showing any alarms or warnings. <br />Alarm history report/log f9r the previous month is available, and has been f -I i <br />Designated UST Operator. (Attach a copy of the alarm history rep2LtIog to this ` <br />Each alarm for the previous month has been responded to appropriately. <br />Sensors located in tank -top containment sumps have not alarmed in the past m <br />- 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 quaftjle�, <br />properly addressed the cause of the alarm. Attach documentation verify7ng appropriate service to <br />properly <br />Is <br />if sump inspection is gired, record results in item 6, below. <br />UST SYSTEM INSPECTION <br />I <br />2 <br />3 <br />—4 <br />5 <br />5a. <br />6 <br />----O'Note: <br />Tank -top containment sumps are free of water, debris, and hazardous substance. Sensors are located properly. <br />Visual inspection ofsuMs is on b� requi din sumps where an alarm has occurred in the Past month or which there is no service record. <br />Y N <br />Y N <br />�m Location: TURBINE SUMP X Sump Location: <br />Sump Location: PIPING SUMP X Sump Location: <br />K il <br />Sump Location: Sump Location: <br />7 <br />Spill containment structures are free of water, debris, and hazardous substance. <br />I I Y N NA I <br />I Y N NA <br />Tank I — Contents: FILL BUCKET X I Tank 3 — Contents: <br />X <br />Tank 2 — Contents: X I Tank 4 — Contents: <br />X <br />8 <br />Under -dispenser containment areas are free of water, debris, and hazardous substance. Sensors are located )roperly. <br />Y I N NA <br />Y N NA <br />Dispenser 1/ 2 X Dispenser 9 /10 <br />X <br />Dispenser 3 / 4 X Dispenser 11 12 <br />X <br />Dispens 5 / 6 X Dispenser 13 14 <br />X <br />DiEenser 7 / 8 X Dg;enser 15 16 <br />X <br />a= <br />PAPERWORK INSPECTION Y N NA <br />Rinmonsommaumm <br />DATE DONE <br />9 <br />Monitoring system certification has been completed within past 12 months. X <br />08/22/2014 <br />10 <br />Secondary containment tests have been completed within the required timeframe. X <br />03/22/2012 <br />11 <br />Spill containment structure (bucket) testing was completed within the past year. X <br />08/22/2014 <br />12 <br />Tank tightness testing was completed within required timeframe. <br />----- — - <br />13 <br />Line tightness testing was completed within required timeframe. SEE COMMENTS X <br />08/22/2014 <br />14 <br />Other required testis maintenance was completed within required timeframe. <br />Test:X <br />03/22/2012 <br />Test/Maintenance: <br />Test/Maintenance: <br />FACILITY EMPLOYEE TRAINING <br />Y N NA <br />15 <br />All ility employees have received the required on-the-job training within the past�year. <br />X <br />16 <br />All facility employees hired within the past 30 days have received the required n-th'ejob train;--- <br />A_j <br />Rote: Any answer of "N" should be explained in the comment section on the following page, and will require <br />follow-up action. 7 <br />Page I of 2 <br />N ovembe't 2004 <br />