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0 0 <br />Designated Underground Storage Tank (UST) Operator <br />Monthly Visual Inspection Checklist <br />W/O#: 120816-023 <br />Facility Name: Mid City Ca FO Re en <br />Date: 9/11/2012 <br />Facility Address: 13850 Devries Road <br />INA <br />City: Lodi <br />Zi Code: 95242 <br />Designated UST Operator Conducting the inspection: Ruben Becerra <br />✓ <br />✓ <br />Internatio 5307833 <br />Si store:, <br />Expiration Date: 04/05/13 <br />Phone: <br />U <br />Location: <br />9 Monitoring system certification has been completed within past 12 months. ✓ 9/11/12 <br />10 Secondary containment tests have been completed within the required. timeframe. ✓ 09/13/10 <br />1.1. Spill containment structurebucket testing was eom feted within the past year. ✓ 9/11/12 <br />1.2 Tank tightness tness testin was cam feted within required timeframe. ✓ <br />13 Line tightness testing was completed within required timeframe. ✓ <br />14 Other required testing/maintenance was completed within required timeframe.(List test/maintenance items below. <br />Test/Maintenance: <br />Test/Maintenance: <br />Test/Maintenance: <br />FACILITY EMPLOYEE TRAINING Y N NA <br />15 All facility employees have received the required on-the-job training within the past year. ✓ <br />16 All facility employees hired within the past 30 days have received the required on -the -lob training. ✓ <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 />Y I N I NA <br />I JYJN <br />INA <br />1 -Contents: DIESEL <br />Y_ -'Contents: <br />✓ <br />E I I ✓ <br />Tank 3 - Contents: <br />I Tank 4 - Contents: <br />✓ <br />✓ <br />r -dispenser containment areas are free of water, debris, and hazardous substance. Sensors are located <br />propert Y. <br />Y N NAY <br />N NA <br />user 112 <br />t/Dis <br />enser 9 / 10 <br />✓ <br />nser 3 / 4 <br />1/Dispenser <br />11 / 12 <br />✓ <br />user S / 6 <br />s/Dispenser <br />13 / 14 <br />✓ <br />nser 718 <br />6/Dispenser <br />1 S / 16 <br />m= ENNEERnm <br />PAPERWORK INSPECTION Y N INA DATE DONE <br />9 Monitoring system certification has been completed within past 12 months. ✓ 9/11/12 <br />10 Secondary containment tests have been completed within the required. timeframe. ✓ 09/13/10 <br />1.1. Spill containment structurebucket testing was eom feted within the past year. ✓ 9/11/12 <br />1.2 Tank tightness tness testin was cam feted within required timeframe. ✓ <br />13 Line tightness testing was completed within required timeframe. ✓ <br />14 Other required testing/maintenance was completed within required timeframe.(List test/maintenance items below. <br />Test/Maintenance: <br />Test/Maintenance: <br />Test/Maintenance: <br />FACILITY EMPLOYEE TRAINING Y N NA <br />15 All facility employees have received the required on-the-job training within the past year. ✓ <br />16 All facility employees hired within the past 30 days have received the required on -the -lob training. ✓ <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 />