Laserfiche WebLink
—M <br /> Designated Underground Storage Tank(UST) Operator <br /> Monthly Visual Inspection Checklist <br /> Facility Name: KlNGCA-MldCity CaFORee= Date: 09/01116 t Y [,U; <br /> Facility AWMS: 13850 Devr-les Road <br /> City: Lodi T_Z_ip—Code: 95242 TAL HEALTH <br /> Desi pated UST Opgatu Conducting the ipRection: David Smith ------E 7 V , <br /> -NT <br /> International Code Council Certification#: 8260473 Ex 'ration Date:20184"7 <br /> signature:David Smith Phone:(SM 511114737 <br /> Y-Yes,N-bio,NA-Not Appcable <br /> Item -MONITORING PANEL I ALARM HISTORY Y <br /> N NA <br /> I Monitoring systemispowered on and in prom operating mode. <br /> 2 M22!!O*gstem isnot currently show's p alarmsorwarnings. <br /> 3 history reporVlog for the previous mouth is available-''and has been review Ey the <br /> Desi ed UST 9 crator. Attach a c o the alarm histo 2r orViog to thisjorm if available) <br /> 4 Each alarm for the Previous month has been responded to Wopriately. <br /> 5 Sensors locate d-m tank containment sumps have not alarmed in the past month. <br /> Sa LW all tank-top sumps where alarms occurred in the past month: <br /> All sensors tested for monitor Certification <br /> Nate:Sumps iK*we an alarm has occurred in the part nuandi mum be frWacted unless a quaftfiedswvIte sedmician respandcxf to.and <br /> properb-addressm.the cause qri*e alarm..!trach docunsewadon iwwns amwrtase seri4ce to this nvorr <br /> #'SWW bmw-don it na*U4 record mufts In Item 6 Wow. <br /> L- 6 Tank-top cgn'wment sumps are N—w-oTw_s!&_,&_W and hazardous substance.Sensors are ImiW�mpieYy: <br /> O'NOW f7sudimperdans afaunWe Is only requkedinsumps wham an alarm has occurmd in the past mawls for%*Ich there is no service n=ni <br /> Sump YI,jN I Y <br /> Location: piping 7 W� Sump Location: <br /> Swnp Location: Sump Location; <br /> SumpLocadon: Sump Location: <br /> of,_ <br /> 7 §jLdl containment structures are free of water debris.and hazardous substance. <br /> Y I N NA <br /> Taiik I -Contents: diesel I ✓ Tank 3-Contents: <br /> Tank 2-Contents: Tank 4-Contents: <br /> 8 Under-dispenser containment areas are five of water,debris,and hazardous substance.Sensors are located <br /> gi§wnser 1/2 <br /> Dispenser 9/10 <br /> Dispenser 3/4 Dispenser <br /> 11112 <br /> Dirppenser 5/ _T_ Dispenser 13 <br /> 114 <br /> Dispenser 7/8 16 <br /> PAPERWORK INSPECTION !!=Y N I NA I DATE DONE <br /> 9 MOMEBM-8 system certific0on,has been comp lctc-d wiffirm-pad 12 09/01/16 <br /> 10 secondary Z3n�uumcnt tests have fican completed within the required timeframe. d 09/12113 <br /> 11 :EA�lcontainment!nqtum bu( completed within the RRst <br /> year. d 09101/16 <br /> 12 Tank tightness testing was coin Ieted within requh-ed timeframe. <br /> 13 Line tightness testing was completed within required tune e. d1 <br /> 14 Other fired testin&aintenance,was completed within required timeframe.aht faulmaintenance items below.) <br /> Test/Maintenance: <br /> YesiolMaintenance: <br /> FACILITY EMPLOYEE TRAINING Y N NA <br /> 15AIlfacility employees have received the required on-the-job n! <br /> 2!N within the eLs. err. d <br /> 16 LA11 facility-em-ployces hired within the past 30 days have received the required on-the-Job training. <br /> Note y answer of'IN"should be explained In the comment section on the following page,and will require <br /> follow-up action. <br /> CIA/CIC APPROVED <br /> 9/1120163:23 PMBrandon Bo <br /> Page I of 2 November 2004 <br /> REV:5.0 <br />