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Designated Underground Storage Tank (UST) Operator w <br /> Monthly Visual Inspection Checklist <br /> Facility Name:Tracy Blvd.Shell Date: 12/22/2010 <br /> Facility Address:3725 Tracy Blvd. <br /> City:Tracy Zip Code:95376 <br /> Designated UST Operator Conducting the Inspection: Brian Dunaha <br /> International Code Council Certification tt: 8021436-UC Expiration Date: 12/10/2012 <br /> Signature: Phone:(888)700 EPIC <br /> Y=yes,N No.NA a Not ARRIlcuble <br /> Item MONITORING PANEL/ALARM HISTORY JYJ N I NA <br /> I Monitorin►system is powered on and in proper operating mode. <br /> _2 Monitoring system is not currentlyshowin p any alarms or warnings. <br /> 3 Alarm history rcport/log for the previous month is available,and has been reviewed by the Im <br /> Designated UST Operator. (Attach a com of the alarm history re porillo r to this form if available.) <br /> 4 Each alarm for the previous month has been responded to appropriately. <br /> 5 Sensors located in tank-top containment sumps have not alamied in the past month. <br /> 5a - Lim all tank-top sumps where alarms occurred in the past month: <br /> Vote:sumps where an alarm has occurred in the past numth must he inspected uu ess a qualified service technidan myonded to,and <br /> prnperlr addrecced,the cause ofthe alarm Attach docume oration verifying appmpriate.set-Wee to this report, <br /> l f.cum p ins h ohms is required.record rom/tc in aenh 6.helmv <br /> UST SYSTEM INSPECTION <br /> 6 "Tank-top containment sumps are free of water,debris,and hazardous substance. Sensors are located properly. <br /> Nwe: Visual imp cction nl'sum a is nnh.req aired io suets wherean alarm has occurred in due past month for which there is no.rentice record <br /> Y I N Y N <br /> Sump Location: Sump Location: <br /> Sump Location: Sump Location: <br /> Sump Location: Sump Location: <br /> 7 Spill containment structures are free of water,debris,and hazardous substance. <br /> Y N A Y N <br /> Tank I —Contents: 87 Tank 3—Contents: 91 <br /> Tank 2—Contents: 89 Tank 4—Contents: Diesel <br /> R Under-dis eraser containment areas arc free of water,debris,and hazardous substance. Sensors are locttted properly.. <br /> Y N NA Y N NA <br /> Dispenser 1 12 Gilbarco MPD ® Dispenser 9//0 Gilbarco MPD <br /> Dis eraser 3/4 Gilbarco MPD ® Dispenser 11/12 Gilbarco MPD Im <br /> Di.c)enser 5/h Gilbarco MPD ® Dispenser 13/14 Gilbarco MPD 191 <br /> Dispenser 7/8 Gilbarco MPD ® Dispenser I i/16 Gilbarco MID IM <br /> PAPERWORK INSPECTION Y N AA DATE DONE <br /> 9 Monito ing system certification has been completed within past 12 months. ® 12/22/2009 <br /> 10 Secol dary containment tests have been completed within the required timeframc. ® 12/2212009 <br /> H Spill containment structure(bucket)testing was completed within the past year. 12/22/2009 <br /> 12 Tank tightness testing was completed within required timeframe. Im <br /> 13 Line tightness testing was completed within required timeframe. (91 <br /> 14 Othcr required testing/maintenance was completed within required timeframe. (List les►/n►aintenance items holow.) <br /> Test/Alaintenance: Air Quality ® 3/05/2010 <br /> Test.41ab►tenance: <br /> TestAllaintenance: <br /> FACILITY EMPLOYEE TRAINING Y N NA <br /> 15 All facility employees have received the required on-the-job training within the past year. Im <br /> 16 All facility employees hired within the past 30 days have received the required on-the-job training. <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 I of 2 <br />