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0 <br />s <br />® <br />Designated Underground Storage Tank (UST) rator <br />Monthly Visual Inspection Checklist <br />Facility Name CANEPA S CAR WASH I Date: November 30 2005 <br />Facili Address: 642 N HUNTER ZIP Code 95204 <br />Cites STOCKTON State CA <br />Designated UST Operator Conducting the inspection: Ron Sanchez 2006 <br />International Co Council rtification #: 5248997 -UC Expiration Date: December 161h, <br />Signature: 1 Date: November 30, 2005 <br />Y= Yes N= No NA= Not A licable <br />Item Monitoring el / Alarm History Y N NA <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 X <br />the Designated UST Operator? (Attach a copy of the alarm report/log to this form if <br />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, <br />and properly addressed the cause of the alarm. Attach documentation verifying appropriate service to this report. If sump <br />inspection is required, put in item 6. <br />USC 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 <br />service record. Y <br />Y N <br />Sum Location UNLEADED X Sum Location SUPREME X <br />Sum Location UNLEADED X Sum Location DEISEL X <br />Sum Location SUMD Location <br />7. Spill containment structures are free of water, debris, and hazardous substance? Y N NA <br />Y N NA <br />Tank 1. Contents UNLEADED I X Tank 3. Contents SUPREME X <br />Tank 2. Contents UNLEADED X Tank 4. Contents DEISEL X <br />8. Under-dis enser containment areas are free of water, debris, & hazardous substance? Sensors are �worlklln roNA <br />Y N NA <br />Dispenser 1 & 2 X Dis enser 9 & 10 X <br />Dispenser 3 & 4 ^ "" """ <br />Dispenser 5 & 6 X Dis enser 13 & 14 <br />Dispenser 7 & 8 X Dispenser 15 & 16 <br />Paperwork inspection Y IN <br />NA Date <br />Done <br />9. <br />Monitoring system certification has been completed within past 12 months? X <br />7/05 <br />10. <br />Secondary containment tests have been completed within required timeframe? X <br />1/05 <br />11. <br />Spill containment structure (bucket) testing was completed in the past year? X <br />7/05 <br />12. <br />Tank tightness testing was completed within required timeframe? X <br />1/05 <br />13. <br />Line tightness testing was completed within required timeframe? X <br />1/05 <br />14. <br />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 <br />Y <br />N <br />NA <br />Date <br />Done <br />15. <br />All employees have received the required on the job training within the past year? <br />X <br />1/05 <br />16. <br />All employees hired within 30 days have received the required on the job <br />training? _ ,..11 renals <br />fnilow-un <br />X <br />action. <br />Note: Any answer or ry <br />