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Designated Underground Storage Tank (UST) p > VED <br /> Monthly Visual Inspection Checklist <br /> Facility Name:French Camp I Date: ` 2 W ;7 F i 7 as <br /> Facility Address: 10842 S.Harlan Rd. <br /> City:French Camp Zip Code:95231 , <br /> Designated UST O r Conducting the Inspection: Steven Richardson <br /> International uncil Certification#:8218604 Expiration Date: 8 / 2. . • "%17 i�', w f. <br /> Signature: Phone: 916 825-7412 <br /> Y=Yes N=No NA=Not Applicable <br /> Item MONITORING PANEL/ALARM HISTORY Y N NA <br /> �u <br /> 1 Monitoring system is powered on and in proper operating mode. X <br /> 2 Monitoring system is not currently showing any alarms or warnings. X <br /> 3 Alarm history report/log for the previous month is available,and has been reviewed by the X <br /> Designated UST Operator. Attach a copy of the alarm history report/logreport/log to thisform if available. <br /> 4 Each alarm for the previous month has been responded to appropriately. X <br /> 5 Sensors located in tank-top containment sumps have not alarmed in the past 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 qualified service technician responded to,and <br /> properly addressed,the cause of the alarm.Attach documentation verifying appropriate service to this report. <br /> I sum ins ection is re uired,record results in item 6,below. <br /> UST SYSTEM INSPECTION <br /> 6 Tank-top containment sumps are free of water,debris,and hazardous substance. Sensors are located properly. <br /> Note:Visual inspection of sumps is only required in sumps where an alarm has occurred in the past month for which there is no service record. <br /> Y N Y N <br /> Sum Location: Sum Location: <br /> Sum Location: Sum 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.DFC X Tank 3—Contents: <br /> Tank 2—Contents: I I Tank 4—Contents: <br /> 8 Under-dispenser containment areas are free of water,debris,and hazardous substance. Sensors are located properl . <br /> Y N NA Y N NA <br /> Dispenser I a X Dispenser 5 X <br /> Dispenser 112 X Dispenser <br /> Dispenser 3/4 X Dispenser <br /> Dis enser 4a/5a X Dis enser <br /> PAPERWORK INSPECTION Y N NA DATE DONE <br /> 9 Monitoring system certification has been completed within past 12 months. X 10-30-14 <br /> 10 Secondary containment tests have been completed within the required timeframe. X 12-17-14 <br /> 11 Spill containment structure bucket testing was completed within the past year. X 10-30-15 <br /> 12 Tank tightness testing was completed within required timeframe. X <br /> 13 Line tightness testing was completed within required timeframe. X <br /> 14 Other required testing/maintenance was completed within required timeframe. List test/maintenance items below.) <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> FACILITY EMPLOYEE TRAINING Y N NA <br /> 15 All facility employees have received the required on-the-job training within the past year. X <br /> 16 All facility -' <br /> em employees hired within the past 30 days have received the required on-theob trainin X <br /> Note: Any answer of"N"should be explained in the comment section on the following page,and will require <br /> follow-up action. <br /> Page 1 of 2 November 2004 <br />