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RECEIVED MEMMM 39-PFJ 618 �* U e Tank FEDesignated HE CALIORNIA G"\ MOperator Inspections PE IT/ 1fI Rev:w1s�2o1 t 8-USTO(8786) Ihonth: MARCH Year: 2014 CUPA Facility 10#: PTO Exp.Date: DO Inspection Date: Designated UST Operator Conducting the Inspection: FA0006672 12/31/2013 m P,rZ X Zo t'f LANCE YORK Facility Name: International Code Council Certification#and Expiration Date: PILOT/ FLYING J - RIPON #618 5296385-UC / SEPTEMBER 1, 2014 Facility U T Ownerl Operator. Facility Contact: DO Stamp and Signature: PILOT /FLYING J BRIAN CAIRNS Facility Address: 4Dr�c��f�t�i' . 1501 JACK TONE RD. r " RIPON, CA 95366 Contact Phone#: ;'j` No.5296355-UC a 209 599-4141 i Q Exp,Sept.1,2014 Checklist Instructions: A UST Designated Operator(DO),who possesses a current"California UST System Operator"certification issued by the International Code Council(ICC) must conduct a monthly visual inspection of the UST system. r;•" The DO must provide a copy of this monthly visual inspection checklist to the UST Owner or Operator. `L y The DO must alert the UST Owner or Operator of any condition discovered y during the monthly visual inspection that may require follow-up actions. The UST Owner or Operator must maintain a copy of this monthly visual inspection checklist and all attachments for the previous 12 months.The records Signature o e gnated Operator must be maintained on-site,or,If approved by the local Certified Unified Program Confir ati of Inspection Agency CUPA)or their desi nate,off-site at a readily available location. a • • • • 1. Is the monitoring system powered on and in the proper operating mode(i.e.,functional and not bypassed)? ❑ ❑ 2. Does the monitoring system show no current alarms or warnings(i.e.,"all functions normal")? ❑ ❑ 3. Is an alarm history report or log for the previous month available and has it been reviewed by the DO?` ❑ ❑ 'Attach a copy of the Alarm History Report/Log to the VIC if available.If not available,explain why not in General Comments section. 4. Has each environmental alarm for the previous month been responded to appropriately,according to the response tog and/or maintenance records?(NOTE-Non-environmental alarms such as for paper replacement,printer error,low 7L ❑ ❑ product,fuel delivery needed,and invalid fuel level,if related to low product in the tank,do not need to be logged.All others do), No environmental alarms since last DO inspection on 5. Have no tank-top containment sump sensor alarms been triggered within the past month? ❑ ❑ 5a. List all tank-top sump alarms triggered in the past month below: (Attach service records for each alarm response) ❑ L-I3 ?,(� - ` - D- 04014 `s t'A >1JSPc�1 l 11 No record L'7 t_ tj (� 05 - I I•srt J CoJc QQs ❑ No record L' DSL 16TP Z 17,3 5 WATT R_(fAlV.:i) I NTR u51©tJ ❑ No record F_A? 2 Ze }t,2t 5 LJp,'ne2•- 1.N"raj_tSt00 ❑ No record L 33 ks? 2l S 6.D•W. S'?, 14;1Z- 2:31, J GoJe e.t-re- ❑ No record L 3 � S e Z2 �(� ?� Z 12;3 4U ❑ No record 7i JAi Mliam" • - For any sump alarms noted in 5a above with no record of a qualified service technician response,answer questions 6 and 6a below. N/A O 6. Are tank-top sumps presently free of water,debris,and 6a. Are tank-top sump probes presently properly located(i.e.,at hazardous substances? lowest point in sump)? (Use General Comments section to note additional details as needed) (Use General Comments section to note additional details as needed) !: ❑ 1 ❑ ❑ ❑ ❑ ❑ ❑ 1 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 0 0 0 ❑ ❑ 0