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Unclerground SbDrage Tank 39-PFJ 618 ° Opwaw Monthly VmmlI ) IMPonthsignat!=Operator Inspedons Rev.•11/lai2011 (949)4586) Month: DECEMBER Year: 2017 CUPA Facility ID#: PTO Exp.Date: DO Inspection Data: Designated UST Operator Conducting the Inspection: FA0006672 12/31/2017 Ve4l; ut�",7Z C7 LANCE YORK Facility Name: International Code Council Cenitication#and Expiration Date: PILOT/ FLYING J - RIPON #618 5296385-UC / AUGUST 2, 2018 8209433 / AUGUST 31, 2018 Facility UST Owner/Operator. Facility Contact DO Stamp and Signature: PILOT /FLYING J SCOTT BRANDAU Facility Address: )?'BI6fY,�p�® 1501 JACK TONE RD. ,`mak® CIE YO RIPON, CA 95366 �� vP Contact Phone O V No.5298385-UC 9Exp.Aug.2,201 B W (209) 599-4141 Checklist Instructions: �q A UST Designated Operator(DO),who possesses a current"California UST System Operator'certification issued by the International Code Council(ICC) pkc must conduct a monthly visual inspection of the UST system. Cit The DO must provide a copy of this monthly visual inspection checklist to the UST Owner or Operator. The DO must alert the UST Owner or Operator of any condition discovered 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 Sign reof ignated Operator must be maintained on-site,or,if approved by the local Certified Unified Program onfi n of inspection A en CUPA or their designate,off-site at a readily available location. iijs • • • • 11- 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 Ristory Reptv&Lcg to the VIC d available.If not evadable,explain why not in General Comments section. 4. Has each environmental alarm for the previous month been responded to appropriately,according to the �{ response log and/or maintenance records?(NOTE Non-environmental alarms such as for paper replacement,printer error,low ISl ❑ ❑ 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) ❑ �-' b'St- Z �� .r� ,�77- &M65 Goth `�oetoZL-1 ❑ No record (r - ❑No recordL.•2`7 45(, TI AM 3 -d S . Q.� ----- 0 No record1 la0 No record f t t t vtew lQ 5KT-- 5-c. [t Zi q `{3,} 9%53� .A.CQR OD&tTr- 8:30-(/ o record 4tq 014,2 a ❑No record i s 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 i 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? lowliest point in sump)? (Use General Comments section to note additional details as needed) (Use General Comments section to note additional Mails as needed) 7El El 11 E] ❑ 11 El El El El 1:1❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ El ❑ ❑ ❑ ❑ ❑ 1771