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SBC <br /> Designated Underground Storage Tank (UST) Operator <br /> Monthly Visual Inspection Checklist <br /> Facilit Marne:Tracy Blvd.SbcB Date: 105/2010 <br /> Facilit Address:3725 Trae Blvd. <br /> City:Tracy Zip Code:95376 <br /> Dunaha I <br /> Internatianat Cade Coon `t Certification : 8021436-L1�C Ex iration Date: 12/06/2010 <br /> Si=nature: Phone:(888)700 EPIC <br /> V=Yes,N=No.NA®Not A 11 bi <br /> ALARM HISTORY Y N NA_ <br /> I Monitoring system is powcrcd on and jjpLo2cr operating mode. <br /> 2 Monitorinsystem is not cufferid, showin,any alarms or warnin s. <br /> Alarm history reportlog for the previous month is available,and has been reviewed by the <br /> Designated UST Operator. (1111ach a copy of the alarm hision,re,ort/lo.,to this tarm if available.) <br /> 4 Each alarm for the revious month has been responded to appropriate <br /> 3 Sensors located in tank-top containment sum ps have not alarmed in the past month. <br /> ;a List all tank-top sumps where alarms occurred in the past month: <br /> Vale:Sumps where an alarm has occurred in the Imst manth must he inspected unless a qualiftedsenice technician responded to,and <br /> properlyaddressed.the cause of the alarm.Attach documentation verifying appropriate service to this report. <br /> stonip ins <br /> of Weston is required,record results in item 6,below <br /> UST SYSTEM INSPECTION <br /> 6 'rank-top containment sumps are free of water,debris,and ha:tardous substance. Sensors are located property. <br /> O'Note.Visual hupectio"a mtr v is on1v r .sunt .s where ate alarm has occurred in the past month for which there is no service recard <br /> V N rt k <br /> Sum Location: lion: <br /> L <br /> Sump Location: Sunt Location: :a <br /> Sump Location: 5 Suffin Location: <br /> 7 S ill containment structures are free of water,debris,and hazardous substance. <br /> V N NA I V F_1NNA <br /> Tank I -Contents: 87 (R] Tank 3-Contents:91 <br /> 8.......J_B I <br /> Tank 2-Contents: 89 Tank 4-Contents: Diesel <br /> 8 Under-disocriser Containment areas are free of water,debris,and hazardous substance. Sensors are located prope ly. <br /> _IN _NA Y N NA <br /> _2t.�ense,//�2G Gilbarco barco?d P�D � 02L sj_,enser 9 10 Gilbarco MPD <br /> Dis enser3/4Gilbarco MPD Im Dis enser 11 112 Gilbarco I <br /> Dh, eLser 5/6 Gilbarco 1VIPD 191 Dt.!tenser 13 14 Gilbarco MPD El <br /> D;. <br /> Spenser 7/8 Gilbarco MPD 0 Dispenser 1St 16 Gilbarco,MPD <br /> PAPERWORK INSPECTION V N NA DATE DONE <br /> 9 -�lonit2am.s stem certification has been cam lased within as�12mont-s- -0- 12/22/2009 <br /> 10 Secondary containment tests have been completed within!2S_ re <br /> n the timeframe.— 91 12/22/2009 <br /> t 1 S ill containment structure(bticket}testin was com !clad within ttre ass ear. 12/22/2009 <br /> 12 Tank tightness testing was corn plctsq.within re uired timeframe. <br /> 13 Line t <br /> 14 cd thriefrarne. (List test/maintenance items below.) <br /> TestlMaintenance: Air Quality im I <br /> —Test4faintenance: <br /> Testl1faintenance: <br /> ----------- <br /> FACILITY EMPLOYEE TRAINING �VTN�N A <br /> t 5 All facili em to ees have received the re uired on-the-°ab trainin*within the ass ear. <br /> 16 Alt facilit em la ees aired within the ass 30 ds shave received the re uired on-the-rob trainin*. <br /> Note; Any answer of"N"should he explained in the comment sectian an the following page,and will require <br /> follow-up action. <br /> Page I of 2 <br />