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0 ! , 15-403 <br /> ,,� .i�aw', a�arat <br /> Designated Underground Stoe T ( e ' � <br /> tllly isul Il tl heck °st C <br /> Facility Name:CA47 19—Manteca Co ate; I 2&16 q M7 <br /> F ._.li Ad mss: _430 W.Center Street Kvu <br /> CiManteca Zi C e: .336 <br /> Designated UST Operator Conducft the in ection® Davtd Smith <br /> International Code Council Certification 8260473 1 Emi on Date:6MI <br /> Signature:David Snifth I <br /> Phone. (W)SM9737 <br /> Y V No,NA NotAp pReattle <br /> Item MONITORING PANEL/ALARM HISTORV Y I N NAI <br /> I Monitoring system isc on and to ro r 0 crating mode. te <br /> 2 totin -system- is not Currentl shovrE ala s or wamita ' <br /> 3 Alarm historyreport/log for the previous on is available.and has been reviewed by the <br /> Designated UST Operator.(Aitaach a . (if the alarm hirtoi re rtl/n to thisform if ailable) <br /> 4a s or the previous inooth has been responded,to appropriately. <br /> � <br /> —ge—nsors located in tank-!2p containment LAM have not alarmed in the pLm mon <br /> a .Gist alttank-toy sumps where olaimsofrurredin thepast month: <br /> th. <br /> Alide.srraa Wrere an alarm has ocevirredin the Putt Humth mum to itt. aaefew. tavltess ar jvVoaded tea,and <br /> tar!t't5•r7ttartvr tha•.evuse al'the attaarrrt.Attack a tocumenteatoaarr txvrf ^rat ctP •aa;,ti`aatc serr��eto tuts a•!.. <br /> L +-4 <br /> ttat iNEESE N__ aar iaaaa is tsa• n8 rrttt.�in ita trt. .below, <br /> S'I SYS TMNSPIb . 1 N <br /> 6 Tank--t containment s of ter,d+e ris, d ous su t ce® r� ht property. <br /> to #'ltttrri iraa ac c tir c q'sar s tr rtt a ,arireat d ra.vxearriax u4mromr trot r%,x or° {din Ow t m h for Wrkh r 0 no 4`001t•e - <br /> V <br /> Y <br /> .Strnr L� tion. _$ 5etrrtp Locati n. <br /> ttnip Location.,tion• Situp Location: <br /> eSttrtr Location. � SumpLoctition. <br /> ill containment structures are free of water.debris.and hazardous t ce. <br /> Y PY NA I Y N NA <br /> Tank I-Contents: diewl Tank 3-Contents: <br /> Tank.2-Contents: -Contents: <br /> ad r-dis r coca t_a,reas am free of water,debris,and dus substance,'tcrisors are located property. <br /> Y N NA Y N PYA <br /> !s riser°1/2 Pipmer 9/10 <br /> i�c arta r 314is er 11 11 <br /> Ibis ser s B 6 P}S riser 13/14 <br /> Dispenser 7/8 Dia reser 1.5 116 <br /> PAPERWORKs E PY Y ll N DATE <br /> 9 Monitoring systcW certific-ation has been completed within past 12 months. 6e O 16 <br /> 10 Second!2 Second! containment tests have completed within a aired three e. i»* 091=14 <br /> I I ill o tai ant bucket to .0 w cat t ' " ithin the t b"" QW43116 <br /> 12 T tightness t _ " completed within`n re u t timeframe. e� _ <br /> 13 testing was completed within required ff-m—eframe. r <br /> 14 Other nuired,testin&aintenance was completedwithin nuired t` ef" e.(List lestlWaintenance items below.) <br /> fi st! nitre n tho 'c, t tion 0&"M4 <br /> Test Maintenance: <br /> TestlMaintenanee., <br /> Imam <br /> FACILITY 1st ' TRAINING IV IN INA <br /> 15 All facili!X empi2yeeshave received the_r aired on- a-'ob training—within the past year. <br /> 1 All facilit 2oyees hired thio e t 3 ys haveeiv t tti on-the-job ink r/ <br /> ote y answer rt s ® d e ex u teed ua c►a t o ® a age.and quTre <br /> follow-up,action. <br /> QA1QC APPROVED <br /> 10/25/20162:15 PMBrandon <br /> Page I of 2 November 2004 <br /> REV:5.0 <br />