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A ,t <br /> Designated Underground Storage Tank(UST) Operator <br /> Monthly Visual Inspection Checklist <br /> FacilityName: KINGCA-Mid City Ca FO Renen Date: 10/04/16 - <br /> Facility Address: 13850 Devries Road <br /> City: Lodi I Zip Code: 95242 I E F <br /> Designated UST Operatior Conducting the i etion: David Smith e NT <br /> International Code Council Certification#: 8260473 1 Expiration Date:6/7/18 <br /> S' :David Smith — Phone SM 58841737 <br /> Y-Yes,N-N%. =NatApplicable <br /> Item MONITORING PANEL/ALARM HISTORY Y N NA <br /> BE 11M MEM <br /> I Mo system is powered on and in proper operating mode. ✓ <br /> 2 Monitoring tem is not current ,showin alarms or warnin ✓ <br /> 3 ; A arm rstory report/log fort the previous month is available,and has been reviewed y ✓ <br /> Desi ted UST Operator.(Attach a co r the alarm history Mo to this rm i mailable. <br /> 4 arm for the previous month has been raponcied to appropriately. ✓ <br /> 5 Sensors luted in"k-top containment sumps have not a!armed in the month. ✓ -- <br /> Sa List all tank top sumps where alarms occurred in the past month: <br /> Nap;:Sumps-&*ere an alarm has accunwd in the pmt month must be f Ww4ed wales&a quaiVW sa7vice teftmlci m respaaded to.and <br /> prapertyaddrrts see the cave afthealarm.Attach doemnmrtadon iwVehtg apprnpdate.servtcr to this n7w% <br /> I/a lion to nxord resuhs iru 107n 6 halo++: <br /> 6 tap carttaiument sumps are fi=of water,debris,and` us su ce.gaors are lova pAs—en,*-e <br /> Nair:f laud Impaa:dans ofsumps is aty nValr ad in sumps whore an alarm has occurred in the para ma thfar%,hich dronY N <br /> Sunt Location: Sump Location <br /> Location: <br /> Sump Location: Sump Location: <br /> 7 S M containment structures are free of water debris,and hazardous substance. <br /> Y I N NA I 1Y N NA <br /> ontente: diesel ✓ Tank 3-Contents: <br /> Tank 2-Contents: Tank 4-Contents: <br /> 8 Und r containment areas are fi=of water,debris,and us substance.Sensors are located er . <br /> Y N N NA <br /> Di er 1/2 Die &ser 9110 <br /> Die er 3!4 Dls neer 11 112 <br /> DispenserS/6 •_; _ Div -..-._. <br /> penser13/14 <br /> Dispenser 7/8 --- -.--;-_ �~� Dlspmtser IS 116 ____---_-__-- �----------.. <br /> PAPERWORK INSPECTION Y N I NA DATE DONE <br /> g sutormg system certification haseen complct@ wt p-a-s-M most ✓ 09101/16 <br /> 10 "T2contammem tests have been com stet within a required ti e. ✓ 09/07/16 <br /> 11 Spill containment structure ucketisatin` was co feted within the year. <br /> ✓ 09/01/ib <br /> 12 Tank d tness test' was co feted within required timeframe. ✓ ---- <br /> 13 Line tightness testing was completed within req e ✓ <br /> 14 Other reggiEd nance was com ted within r uired timeframe.gbt tesdntainterrance items below. <br /> Test/Maintenanee. <br /> TesvMaintenance. <br /> Test/Malmenarce. <br /> FACILITY EMPLOYEE TRAINING IY N NA <br /> 15 All facilit employees have received the uired on-the-'ob train' within the post ✓ <br /> 161 facility employees hired within the past 30 days have received the required on-the-Job training. se <br /> Note:Any answer o s o e e a comment sec on on t o o ng page,a requ e <br /> follow-up action. <br /> OA/OC APPROVED <br /> 10/5/20167:49AMBrandon Bo <br /> Page I of 2 November 2004 <br /> RFV:5.0 <br />