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FROM FAX NO. :12093690153 &b. 08 2010 10:06AM P10 <br /> tNDERGROUND STORAGE TANK SYSTEM <br /> DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT <br /> Facility Name: Econo Gas Inspection Date: May 22, 2009 <br /> Facility Address: NO E.Victor Road City- Lodi <br /> Name ofDesignMdUST opomtorConducting Inspection: Alex.labbad <br /> InternationalCodeCouncil Certification No.: 5243897'-UC Expiration Date: 9/27/2010 <br /> Signature: Phone: (925) 389-1262----1 <br /> NIA-Not AmOkable <br /> Item MONITORING PANEL/ALARM HISTORY Yes No -N/A <br /> i, is the montunigg Ustem powered on and in ZoM%S*m made? <br /> A <br /> 2. is the tern not currently showing an leek alarms? <br /> 3. Is the Alarm Hbvmy Report/log fur the previous month available,and has it been reviewed by the <br /> Desi Eated UST 2P—OMor? (Attach a coM 4*alarm hkLmzMioltathis ins pectionform. <br /> 4. Has each alarm for ).- <br /> Wft i=vious InOmth been to MuL.LL <br /> 1 for <br /> UST SYSTEM INSPECTION <br /> 5. Are tank-top containment sumps free of water,debris,and hazardous substance? Moo;If the amwr to Item 4 was'Tex"or <br /> "NA"Aip to to 6.&uws whet an alarm has omurmd in the past month must be bwcW if a qw4$vdwrvivu tothnician has not responded <br /> to and pwar&adftsw4 the=sea the ctlarm <br /> moom wr6,&w S98MgqqLk mmkt should be attached to dna re�aort <br /> No sumps alarmYes 0 i?4 No sum p§alarm Yes No 0'. <br /> So cation, Sum Location: I LJ <br /> -S2M Location: M l SumWcation: <br /> 6. Are sVM buckets(colftlinment structuress 0 of water,debris,andhazardous substance? <br /> es No N/A I Yes I No N/A <br /> Tank I ID-lteTank 3 10-Die"I 0-1 <br /> Tank 2 ID-Premium N I E] I Lj Tank 4 ID-- <br /> 7. <br /> i. Are under4spenser containment areas free of water,debris,and hazardous substance? <br /> Yes I No I I Yes I No I N/A <br /> Dig neer-M2 Dis ser-9110 <br /> Disposer-3/4 Dig -11/12 <br /> Dis ser-13/14 <br /> D' ser-7/8 ser-15/16 <br /> S. Leak detection is proverly located within spenm containment. <br /> Yes No-I /A I No N/A <br /> Pen <br /> D's <br /> D 2i� <br /> El <br /> in under-di <br /> Yes <br /> Di®Euser-1/2 Dis -9/10 0 <br /> Di ser-3/4 Dilspmw-11/12 11 0 <br /> Di!Mser-516 Di ser y-13/14 0 <br /> Dispenser-7/9 EJ Di W-15/16 11 <br /> Date Dome <br /> PAPERWORK INSPtCTION Yes I No I N/A 6., <br /> 9. Monitoring Systern Certification was completed within the post 12 months? 1=008 <br /> 10, Secondary cwtainment too completed within the required time frame? 2/27/2007 <br /> _1 I. Spill bucket(containment structure)testing completed within the Pad 12 months? 1212212008 <br /> 12. Tank tightness testing completed within the required time frame? <br /> i3, Line tightness testing completed within the required time fime? =—T—M <br /> 15. OtherT <br /> Maired �maintenance was compfeted within required time flame? (Lbt tesb'malmenance items <br /> Descri7be TestUainowce:TP-201.3 and TP-201.4 N I Q 1/21/2009 <br /> Describe Test/Maintenance: U. I ICE3 <br /> FACILUY EMPLOYEE TRAMING Yes No NIA <br /> 16, 1 Have an fficifity® to ees received the Maired on4he-job t!!Lji�n within the Mt yW <br /> 1.Have all facie'!!=!o , the <br /> Xces hired within ft est 30 da received the LeLWmd on- jobtrain6-9 <br /> Ncft. Explain any"No"answers in the"Comments"section on the following page.Those issues require corrective action from <br /> the UST owner/operator. <br />