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2098253893 ENGINEERING DEPT. 106 a.m. 08-27-2009 9117 <br /> Designated Underground Storage Tank (UST) Operator <br /> Monthly Visual Inspection Checklist <br /> Facility Name: Kaiser Permanente Watecsa Date: 07/22/09 <br /> Facility Address: 1777 W.Yosemite <br /> Ci : Manteca Zi Code: 95337 <br /> Designated UST Operator Conducting the Ins ction: Thomas Hin to II <br /> International Code Council Certification 0: 5301063-UC j Expiration Date: 12/12/2010 <br /> Si tore:Thomas Han stop 11 Phone: 707 2954066 <br /> Y=Yes,N d No.NA=Not Applicable <br /> Item MONITORING PANEL/AL HISTORY Y N NA <br /> I Monitorin system is powered on and in ro er o tin anode. X <br /> 2 . Monitorings tem is not current! showingan alarms or warnin . X <br /> 3 Alarm history report/log for the previous month is available,and has been reviewed by the <br /> Desi ted UST erator. Attach a co o the alarm histo re rt/lo to this,form i available) X <br /> 4 Each alarm for the previous month has been responded to a riatel . X <br /> 5 Sensors located in tank-top containment sum s have not alarmed in the month. X <br /> 5a 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 quaked service technician responded to,and <br /> properly addressed,the pause of the alarm.Attach documentation verifying appropriate service to this report. <br /> 1 sum ens Ction is r uired,record results In item 6,below. <br /> J a�*ego <br /> LIST SYSTEM INSPECTION <br /> 6 'T'ank-top containment sumps are free of water,debris,and hazardous substance. Sensors are located properly. <br /> (dote:Visual Insecdon o .sums Is onl required in sum where an alarm has occurred In the t month r which there is no service record. <br /> Y N Y N <br /> §ymg Location: Sum Lowtion: <br /> Sump Location: Sump Location: <br /> �- Sum Location: Sum Location: <br /> 7 Spill containment structures are free of water,debris,and hazardous substance. <br /> Y N NA Y N NA <br /> Tank 1-Contents: Diesel X Tank 3-Contents: <br /> Tank 2-Contents: Tank 4-Contents: <br /> 8 o dispensers are utilized at this facility X <br /> PAPERWORK INSPECTION Y N NA DATE DONE <br /> L12Monito ' stem certification has been completed within t 12 mrontbs. X 08/29/08 <br /> Secondarywire <br /> containment tests have been completed within the re d timeframe." X 04/07/06 <br /> IS ill containment structure bucket testin was con feted within the ast year. X 08!29/08 <br /> Tank ti fitness testin was leted within re uired ' e. X <br /> Line tightness testing was con feted within required timeframe.* X I I 08/29/08 <br /> 14 1 Other required testin maintenance was completed within Eeguired timeframe. List testlmaintenance items below. <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> TestlMaintenance: <br /> H <br /> FACILITY(EMPLOYEE TRAINING Y I N NA <br /> 15 All Facili em io ees have received the r wired on-the=ob trainingwithin the t year. 12/16/2008 X <br /> 16 All faeili em to ees hired within the past 30 da have received the aired on-the-'ob training. X <br /> Note: Any answer ofµN"should be explained in the comment section,and will require follow-up action. <br /> Comments: No alarm history print out available.Owner(KCS P1V12 advises facility working with county to obtain <br /> permit forpiping installation,will advise status upon resolution. *Owner to schedule line test upon resolution with <br /> conn . *Owner should notiN County re.UST status and inquire whether SB989 testing should be performed. <br /> Follow up Actions: <br /> Page I of 1 November 2004 <br />