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so <br /> wio#: ��an�-sss <br /> Designated Underground Storage Tank(UST) Operate y= <br /> Monthly Visual Inspection Checklist <br /> Facility Name: lGNGCA/Mid City Ca FO Regen I Date: 08/30/17 <br /> Facility Address: 13850 Devries Road <br /> C' : Lodi 7a Code: 95242 <br /> Desi UST Operator Conducting the' ection: 'Ruben Becerra n a LT <br /> International Code Council Certification# 5302139 ftiration Date.1/18/19 <br /> Si :Ruben Becwm = Phone:(888)58841737 <br /> Y=Yes,*4 No,NA Not Applicable <br /> Item MONITORING PANEL-,,/ALARM MSTORY Y N NA <br /> isgamus3mME <br /> I Monito' is powered on and in proper operating mode. t/ <br /> 2 Monito. system is not gEpLntr show.*&an alarms or . ' <br /> 3 Alarm history report/log for the previous month is available,and has been reviewed by the ✓ <br /> Desi bed UST Operator.(Attack a M{ the alarm histo r ort/lo to this rm i available.) <br /> 4 Each alarm tOr the previous Month has been respondedto appropriately, ✓ . <br /> 5 Sensors located in"k-t9p containment sipps have not al m the past mo <br /> Sa Gist all tank-top sumps where alarms occurred in the past month: <br /> all alarms set off today,due to a Mon-cert performed.all alarms were cleared. <br /> Now sangm where an alarm has o=Wred in the past month raust be OWected unleac a qua46ed service tecludctan rrsponded to.and <br /> prop�rl�addmsse�the carie y7he alarm.Attach rtacumentad.gime appaWdate senice to this np nr. <br /> I's ttom rs <br /> rewdre4 nvard msutts in item 6 blow. <br /> 6 -top contturunent sumps are o water, us su ee. errors are oral prope y. <br /> Noce:!?seal hopwilow ofs tnw to only required in sumps where an alarm has oceto-red in the past manthfor which there is no service record. <br /> Y N MW I Y N <br /> Sum Location: space I d/ SWp Location: vent box ✓ <br /> Sump_Location: piping snntp _ 1 ✓ um Location: <br /> Sump Location n box ✓ rep oc a'ion: -—�-- – <br /> 7 S ill containment structures are free of water debri&and hazardous substance. <br /> I INNA it Y I N NAS <br /> Contents:Diesel Tank 3-Contents. <br /> Tank 2-Contents: Tank 4-Contents: <br /> 8 Under-dis reser containment areas are free of water,debris,and hazardous substance.Sensors are located properly. <br /> Y N NA Y \' NA <br /> phpmer1/2 Dis erg/10 <br /> Dip eraser 3/4 Dis neer d//12 <br /> Dispenser 5/6 _ PypenW 13/14 . <br /> D' neer 7/8 _ _ Dispenser IS/16ME 11111111 MW <br /> PAPERWORK INSPECTION Y Y NA DATE DONE <br /> 9 t s <br /> nitoring system cercation has baso completedwr past moat ✓ 08/30/17 <br /> 10 Secondary con tarnmenttests&Weleen—com–pl&@ witlmn the requi times ✓ 09/07/16 <br /> 11 Spill conWrnnent structure ucket)testing was completed within the year. ✓ 08/30/17 <br /> 12 Tank HOW=testis was c2MRleted within timeframe. ✓ <br /> 13 Line tightness testing was completed within required time 'e. V <br /> 14 1 Other required testi bntenance was completed within required timeframe.&W twtlntaintenance items below. <br /> TeWMaintenuncv: <br /> Test/Maintenance. <br /> Test/Maintenance: <br /> RUN <br /> FACILITY EMPLOYEE TRAINING Y IN NA <br /> IS All fac <br /> ft ME19yees have rived the r aired on-!he-job train within the past yew. e� <br /> 16 Ali facility employees hired within the past 30 days have received the required on-the-Job training. ✓ <br /> Note: y answer 51 MY;SFO-iailbe explained In ifie comment on on the following page,and will require <br /> follow-up action. <br /> QA/QC APPROVED <br /> 8131/20178:32 AMBrandon Bo <br /> Page 1 of 2 November 2004 <br /> REV:5.0 <br />