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d q <br />Designated Underground Storage Tank (UST) Operator <br />Monthly Visual Inspection Checklist <br />C <br />Facility Name: SJC Motor Pool N-2906 Date: 5/31/05 <br />Facility Address: 121 S. San Joaquin St. <br />City: Stockton Zip Code: 95205 <br />Designated UST Operator Conducting the Inspection: Richard Tira elle <br />International Code Council ertification #: 5248958 -UC <br />Expiration Date: 12/08/2006 <br />Signature: <br />Phone: 209 ) 468-4645 <br />I— Y = Yes, N = No, NA = Not Applicable <br />Item <br />MONITORING PANEL / ALARM HISTORY <br />Y <br />N <br />NA <br />__,,.. ,.. i,w .. ,� .... .,,,. _.. ... .. ..,�.p. r. _.,ar ., ., ,� ,.,.. <br />w, <br />..__.� <br />..� , <br />1 <br />Monitoring system is powered on and in proper operating mode. <br />Y <br />2 <br />Monitoring system 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/logreporillog 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 />If sum ins ection is re wired, record results in item 6, below. <br />:� aid,- flyi rWrv4:.`. r,^ 7,7 <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 sums is only required in sumps where an alarm has occurred in the past month or which there is no service record. <br />Y NN <br />h� <br />nfx9 £ <br />Y <br />f <br />Sump Location: <br />u <br />Sump Location: <br />Sump Location: <br />Sump Location: <br />Su;mp Location: <br />Sump Location: <br />7 <br />Spill containment structures are free of water, debris, and <br />hazardous substance. <br />Y N NA <br />N NA <br />Y <br />Tank I — Contents: UNLEADED Y <br />Tank 3 — Contents: <br />Tank 2 — Contents: <br />Tank 4 — Contents: <br />8 <br />Under -dispenser containment areas are free of water, debris, and hazardous substance. Sensors are located properly. <br />Y N NAN INA <br />Y <br />Dispenser I / 2 UNLEADED Y Dispenser 9110 <br />Dispenser 3 / 4 Dispenser 11 / 12 <br />Dis enser S / 6 Dispense 13 / 14 <br />Dis enser 7 / 8 Dis enser I S / 16 <br />\1r.E777 <br />PAPERWORK INSPECTION <br />Y <br />N <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 />H S ill containment structure bucket testing was completed within the past year. <br />12 Tank tightness testing was completed within required timeframe. <br />13 Line ti htness 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 />Page 1 of 2 November 2004 <br />