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Designated. Underground Storage Tank (UST) Operator <br />Monthly Visual Inspection Checklist <br />Facility Name: TESORO 68151 <br />Date: 11/6/2015 <br />Facility Address: 35 N Cherokee Lane <br />INA <br />City: Lodi TZip <br />Code: 95240 <br />Designated UST erato Cond ting the Inspection: Laura Gomez <br />International /DYC2#I C ication #: 8344748 <br />Expiration Date: 4/14/2017 <br />Sign e: <br />Phone: (949) 460-5240 <br />( % . —/, —t ' 1 / 1 Y = Yes, N = No, NA = Not Applicable <br />Ite <br />7 i4bNITORING PANEL / ALARM HISTORY <br />Y N <br />INA <br />I <br />Monitoring System is powere on and in proper operating mode <br />X <br />2 <br />Monitoring system is not currently showing any alarms or warnings. <br />X <br />3 <br />Alarm history report/log for the previous month is available, and has been reviewed by the Designated UST <br />Operator. (Attach a copy of the alarm history reportilog to this form if available.) <br />X <br />4 <br />Each alarm for the previous month has been responded to appropriately. <br />X <br />5 <br />Sensors located in tank -top containment sumps have not alarmed in the past month. <br />X <br />5a <br />- List all tank -top sumps where alarms occurred in the past month: <br />Note: Sumps where an alarm has occurred in thepast month macs he inspected unless a qualified service technician responded <br />addressed, the cause of the alarm. Attach documentation verifying appropriate service to this report. If sump inspection is required, <br />in item 6. below. <br />to, andproperly <br />record results <br />UST SYSTEM INSPECTION <br />6 <br />Tank -top containment sumps are free of water, debris, and hazardous substance. Sensors are located properly. <br />Note. Visual inspection gfsumps is only required in sumps where an alarm has occurred in the past monthfor which there is no service record. <br />Sump Location: rSump <br />Y 11111, <br />Location: TM"` <br />.Sump Location: 1A <br />Location:^Sump <br />Sump Location: N`4 <br />Y N <br />,.... <br />Sum Location:RA <br />p <br />7 <br />Spill containment structures are free of water, debris, and hazardous substance. <br />Y I N I NAT <br />N <br />NA <br />Tank -87 X Tank -91 <br />X <br />Tank -Diesel X <br />8 <br />Under -dispenser containment areas are free of water, debris, and hazardous substance. Sensors are located properly. <br />Y N NA <br />Y N <br />NA <br />Dispenser -1 /2 X <br />Dispenser -3/4 X <br />Dispenser -5/6 X <br />Dispenser -7/8 X <br />PAPERWORK INSPECTION Y N NA DATE DONE <br />4 <br />Monitoring system certification has been completed within past 12 months. X <br />1/28/15 <br />10 <br />Secondary containment tests have been completed within the required timeframe. X <br />1/x3/14 <br />11 <br />Spill containment structure (bucket) testing was completed within the past year. X <br />1/28/1.5 <br />12 <br />Tank tightness testing was completed within required timeframe. X <br />NIA <br />13 <br />Line tightness testing was completed within required timeframe. X <br />N/A <br />14 <br />Other required testing/maintenance was completed within required timeframe. (List test/maintenance items below) <br />Test/Maintenance: X <br />N/A <br />Test/Maintenance: X <br />N/A <br />Test/Maintenance: X <br />N/A <br />FACILITY EMPLOYEE TRAINING <br />Y N <br />NA <br />15Ali <br />facility employees have received the required on-the-job training within the past year. <br />X <br />161 <br />All facility employees hired within the past 30 days have received the required on-the-job training. <br />I X <br />Note: Any answer of "N" should be explained in the comment section on the following page, and will require follow-up <br />action. <br />Page 1 of 2 <br />