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Facility Name: <br />Inspection Date: <br />Facility Address: <br />City: n <br />Name of Designated UST Operator Conducting Inspection: Evangelina Barroso-Traylor <br />International Code Council Ccrtifica€ion No.: 8200888 -UC <br />Expiration Date: 3/30/2017 <br />Suture: i 3 - _ _ - <br />Phoae: (909) 455-2275 ext. <br />1f 1 m i\pf APPUC301C <br />Item I <br />'MONITORING PANEL / ALARM HISTORY <br />Yes No I N/A <br />1. <br />Is the monitoring system powered on and in proper operating mode? <br />QF El I <br />2 <br />Is the monitorings tem not currentl showing any leak alanns? <br />E'' El 1 <br />3. <br />Is the Alanu History Report/log for the previous month available, and Inas it been reviewed by the <br />Designated UST Operator)_ (Viac•h a co v o the alarm histary re ort/log to this ins xvionfirm.) <br />4. <br />Has each alarm for the previous month been responded to appropriately? <br />r <br />UST SYSTEM INSPECTION <br />5. <br />Are tank -top containment sumps free of seater. debris, and hazardous substance? Nate: ifthe amnrr to Item d was 'Tes,' bp <br />to limn 6. Sumps where m alarm has txcuned ht the past month rawest he inspected if a quatired setrrce techn0cm has not responded to, and <br />o ern - addressed. the carne of the Aim). Dommentotion regi i-ing a aro rrarte sell -we should he attached to this report. <br />ocatian <br />Yes <br />No <br />Sum Loclon:unp <br />Ys <br />; <br />---- <br />SumpLocation. <br />Sura Location: <br />❑ <br />6. <br />Arc spill buckets (containtnetnt structures) free of water, debris. and hazardous substance'? <br />Yes No I <br />Yes No N/A <br />Tank 1 ID —' r-' I Lj I Tank 4 ID — <br />Tank 2 ID — Tank 5 ID — <br />Tank 3 ID — Tank 6 ID — <br />.- <br />7. <br />Are under -dispenser contaimnent areas free of water, debris, and hazardous substance? <br />Yes No I N/A <br />Yes No N/A <br />Dispenser — 1/2 i ' Dispenser—W10 <br />Dispenser — 374 Dis enser— 11/12' <br />Dispenser — 516 El 1 Dispenser— 13/14 <br />- <br />Dispenser — T"S U I Dispenser — 15/16 <br />R. <br />Leak detection is properly located within under-dis enser containment. <br />Yes No ; <br />Yes No N/A <br />_ <br />Dispenser — 1/2 Dis enser — 9/ 10 <br />Dispenser — 314 Dispenser — 11/12 <br />Dis enser — 516 Dispenser — 13/14 <br />El Q <br />DlSpenscr _7_8 t ' Dis enser— 15/16 <br />PAPERWORK INSPECTION Yes No N/A <br />Date Done <br />9. <br />Monitoring System Certification was completed within the past 12 months? - - F1 I Li <br />xv <br />10. <br />Line Leak Detectors were tested'ccrtified within the past 12 months? U 10 <br />512-1 <br />ll* <br />12. <br />Spill bucket (containment structure) testing completed within the past I2 o s? <br />Line tightness testing completed within the required time frame'? <br />13. <br />Secondary containment tests completed within the required time frame?' <br />_= ` <br />14. <br />Enhanced Leak Detection completed within the required time frame? <br />15. <br />Other required testin ='maintenance was completed within required time frame? (List test/rrraintenance items below.) <br />Describe TestiMainicnance: <br />Describe Test Maintenancc: <br />FACILITY EMPLOYEE TRAINING <br />Yes No N/A <br />16. <br />Have all facility employees received the required on-the-job training within the past year? <br />17. <br />Have all facility employees hired within the past.30 days received the required on-the-iob training'? <br />Note: Explain any "No" answers in the "Comments' section on the following page. Those issues require corrective action from <br />the UST owner/operator. <br />UNAV - 112 <br />ss ww. unianes.org <br />9/26/05 <br />