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06/05/15 03:15PH HP LASERJET FAX 2099551865 P.10 <br />RECEIVEL <br />Designated Underground Storage Tank, (UST) Operator /1 0 <br />Monthly Visual Inspection Checklist 0 5 2015 <br />rte•Iai <br />Facility NncMatwimer 1-5 Arn/Pffl <br />-- - ------ TAL <br />a ility Addre m., _5() W. Hatniner Lane, <br />-r4fil -NIT <br />95207 <br />Cjtv: Stockion Ca Zip C e <br />(gator (. onduclixig the Insmclion: Lyle Meeks Nvith 17173117-0-Hill COFI). <br />r-�,jLa6on Date: 11 19-201 i <br />5teriwatiomal "e Council cmification #:-x-1807�53(jc <br />Rhoue: ( 559 ) 805-3367 <br />ti 1k No, N,Not t k licah <br />MONITORING PANEL 1ALARM HISTORY =YF7NJI <br />a m ..:,_,._.._.._ <br />Mani r til%'T <br />Hitt <br />been review-ed by the x <br />T­ —XG�11 history rwil/log for die pi-evioUs 111opoi is avai I-, and has <br />q1 e d U S T Op S! a t 0 this -l) mr, 1! n?�' I-q 61 -e <br />x"' <br />X <br />X <br />4 Eflcb alarin �01` dLCJE�'N' �(us month has been responded ya) affr2priateiv, x -11 <br />_x <br />5 1;,;e)isorS located in ta�!L jtqjpjjj <br />not alarmed in ast n <br />5a List all lank-lop vurripS aleirms excurred in the posi month. . ....... .... <br />------------ <br />unips where ran arm lym or carred in the Aust jn,.,)nth must be. insIveted yonloss a quallfied servive techtuviun rc Apypnded to, and <br />1proporly eid(Imssed, the cause of the alarm. Attach documMU'rion ver0lmg ejpprqvie�fe ft.'MCS to this report. <br />.............. ......... . <br />UST SYSTEM <br />...... . .....M. .. .... <br />6 Tank-top, C...olitailIP(SUMPS11te free of water, debris, and Waaardous subsuince. Scils trs arc located properly, <br />W in the P0.1i Mon <br />em all 01(Arm has 0004rre <br />v N <br />irrrr Location., 1:ocafiow <br />*mp <br />7 <br />hmardous substance, <br />itWiiwe', arc O�'Aatcrt debris. and <br />Y N LA] <br />TW*3 X' <br />"x <br />Tank 2 •--m <br />Com Tank Bff.KE-7s, <br />er, dcbr c, and hazardous substance. Sensors are located <br />8 Under-dLsp�e 1sff CqVitshillicilt areas are free Of wal <br />N NA <br />Y N NA <br />j Jy mver [)ispenser 9., 10 <br />j . .. .... .. <br />we 3.,'4 <br />. . ........ <br />Ave K!I.- 6 L)isvenser 13.1 14 <br />. .... ..... <br />PAPERWORK INSPECTION Y N NA DATE DONE <br />catiou bas ken con <br />0 sec nivient tests have been completed within thecouired tioneframe. x <br />ontailimcnt 11 (bucket) lestin 5-1-12 <br />Ely! :Sr?n the <br />.... . ... ...... <br />Tank compic'I W1within required fimcframe. <br />13 I.q1c tightness witin vithin rp� <br />�Irc� (im0fra. like. <br />.... . ......... . . . .. <br />d Tinamtenanee items behmj <br />Othcj'Lc �innm�intemjm:E -was Completed withillioTlire timef Inc, fl'ist <br />FACILITY EMPLOYEE TRAINING Y N NA <br />A if <br />Lot� Aral un»wcr of N� shnald be exltlainecl Irt the corttnaen# scc#i raft tttt #Itc fniiowirt #tam+enc! w'iII regatta <br />follow-up <br />n- <br />follow-up Action. <br />