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C <br />Designated Underground Storage Tank (UST) Operator <br />Monthly Visual Inspection Checklist <br />Facility Name: SJC MOTOR POOL N-2906 <br />Date: 6/30/05 <br />Facility Address: 121 S. SAN JOA UIN ST. <br />N <br />City: STOCKTON <br />Zip Code: 95205 <br />Designated )nducting the Inspection: RICHARD TIRAPELLE <br />International Code Council Certification #: 52489 UC <br />Expiration Date: 12 / 08 / 06 <br />Signature: a <br />Phone: 209 468-4645 <br />Y = Yes. N = No. NA = Not ADDlicable <br />Item <br />MONITORING PANEL / ALARM HISTORY <br />Y <br />N <br />NA <br />Monitoring s stem is powered on and in proper operating mode. <br />Y <br />7OM <br />7-7 <br />1 <br />2 <br />Monitoring s stem is not currently showing any alarms or warnings. <br />Y <br />3 <br />Alarm history report/log for the previous month is available, and has been reviewed by the <br />Designated UST Operator. Attach a copy of the alarm history report/logreport/log to thisform if available. <br />Y <br />4 <br />Each alarm for the previous month has been responded to appropriately. <br />Y <br />5 <br />Sensors located in tank -top containment sumps have not alarmed in the past month. <br />Y <br />5a <br />_ List all tank -top sumps where alarms occurred in the past month: <br />Note: Sumps where an alarm has occurred in the past month must be inspected unless a qualified service technician responded to, and <br />properly addressed, the cause of the alarm. Attach documentation verging appropriate service to this report. <br />Ifsump inspection is re wired, record results in item 6, below. <br />y <br />UST SYSTEM INSPECTION <br />6 <br />Tank -top containment sumps are free of water, debris, and hazardous substance. Sensors are located properly. <br />Note: Visual inspection o sum s is only re uired in sumps where an alarm has occurred in the past month or which there is no service record. <br />Y N <br />N <br />Y <br />Sump Location: <br />, . Sump Location: <br />Sump Location: <br />Sump Location: <br />Sump Location: <br />Sump Location: <br />7 <br />Spill containment structures are free of water, debris, and hazardous substance. <br />Y N NA N NA <br />Y <br />Tank 1 —Contents: UNLEADED Y Tank 3 — Contents: <br />Tank 2 — Contents: Tank 4 — Contents: <br />8 <br />Under -dispenser containment areas are free of water, debris, <br />and hazardous substance. Sensors are located <br />properly. <br />Y N NA <br />Y <br />N NA <br />Dis enser 1 / 2 UNLEADED Y <br />Dispenser 9110 <br />Dis enser 3 / 4 <br />Dispenser 11 / 12 <br />Dispenser 5 / 6 <br />Dispenser 13 / 14 <br />Dispenser 7 / 8 <br />Dis enser 15 / 16 <br />PAPERWORK INSPECTION <br />Y <br />N <br />W, <br />NA <br />DATE DONE <br />9 Monitoring system certification has been completed within past 12 months. <br />10 Secondary containment tests have been completed within the required timeframe. <br />11 Spill containment structure bucket testing was completed within the ast year. <br />Y <br />6/17/05 <br />12 Tank tightness testing was completed within required timeframe. <br />13 Line tightness testing was completed within required timeframe. <br />Y <br />6/17/05 <br />14 Other required testing/maintenance was completed within required timeframe. List test/maintenance items below. <br />Test/Maintenance: <br />Test/Maintenance: <br />Page 1 of 2 <br />November 2004 <br />