Laserfiche WebLink
W/O#: 1 120921-358 <br />Designated Underground Storage Tank (UST) Operator <br />Monthly Visual Inspection Checklist <br />Facility Name: Mid City Ca FO 'Re en <br />Date: 10/10/2012 <br />Facility Address: 13850 Devries Road <br />City: Lodi <br />Zi Code: 95242 <br />Designated UST Operator Conducting the inspection: RUBEN BECERRA <br />lnternatio 530 7833 -UC <br />Si ature:4814 A <br />Fx iration Date: 04/05/13 <br />Phone: <br />I VF IVJiev l6 I-lNV.W % e Y.CS, I'% — Iqu, n1k —nut k%PV ':KU1C <br />Item MONITORING PANEL / ALARM HISTORY Y I N I NA <br />I Monitoring system is powered on and in proper operating mode. ✓ <br />2 Monitoring system is not currently showing any alarms or warnings. ✓ <br />3 Alarm history report/log for the previous month is available, and has been reviewed by the <br />Designated UST Operator. (Attach a copy (if the alarm history report/log to this farm if available.) <br />4 Each alarm for the prev-io-u—smorifth has been respon to—appropriately. ✓ <br />5a5 Sensors located in tank -top containment sumps have not alarmed in the past month. <br />List all tank -tap sumps where alarms occurred in the past month: <br />7 <br />ill containment structures are free of water, debris and hazardous substance. <br />Y N I NA I I Y <br />N NA <br />Tank 1 - Contents: DIESEL ✓ Tank 3 - Contents: <br />Tank 2 - Contents: Tank 4 -Contents: <br />8 <br />Under -dispenser containment areas are free of water, debris, and hazardous substance. Sensors are locatedproperly. <br />Y N NA Y <br />N I NA <br />Dispenser 1 / 2 Dispenser 9 / 10 <br />Dispenser 3 / 4 Dispenser 11 / 12 <br />Dispenser 5 / 6 Dispenser 13 / 14 <br />Dispenser 7 / 8 Dispenser 15 / 16 <br />PAPERWORK INSPECTION Y N DATE DONE <br />9 <br />Monitoring system certification has been completed within past 12 months. ✓ <br />0.9/11/1.2 <br />10 <br />Secondary containment tests have been completed within the required timeframe. ✓ <br />IV&/ <br />09/13/10 <br />i i <br />S ill containment structure bucket testis was com leted within the ast year. ✓ <br />09/11/12 <br />12 <br />Tank tightness testin was completed within required timeframe. <br />13 <br />Line tightness testing was completed within required timeframe. ✓ <br />14 <br />Other required testing/maintenance was completed within nuired timeframe. List test/maintenance items below. <br />Test/Maintenance: <br />TestlMaintenance: <br />FACILITY EMPLOYEE TRAINING Y I N I NA <br />15 All facility employees have received the required on-the-job training within the pastyear. ✓ <br />16 All facility employees hired within the past 30 days have received the required on -the -Job training. I I✓ <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 1 of 2 November 2004 <br />