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U) -0 0 W <br /> O m D <br /> (D O Q_ <br /> 1v (n ( <br /> O <br /> Z U� <br /> , pERGROUND STORAGE TANK SYSTEM W (D <br /> �SJGNAED UST OPERATOR MONTHLY INSPECTION REPORT �' 0 <br /> SD p Inspection Date: 7 N O <br /> e SiffC-L _— — / � O m <br /> ITl Fa.00 Nxn: L City:.5 t= I� -_ O <br /> 2 .s c/ 5 ' 00 tb(Q <br /> U) F i1in•id - P Douglas Nunn <br /> aced tPSTnPeretor Conducting"Isection: 0 <br /> Name of D"Jr, O fn <br /> "tied Certification No.: 5238716 Expiration Date: <br /> codeco 712 512 0 1 9 -p 'r <br /> Inienrenonat _ %' ne:Pho <br /> (510)894-1401 ext. O _ <br /> Si f✓ vA=\ot A O <br /> MOI9TCORING PANEL,'ALARIVI HISTORY 0 <br /> ower,(,on and in ro er o eratiniz mode? Yes No -. <br /> item stem O <br /> lsihemonitorim `' O <br /> monitonoe system not currently showingan leak alarms? = <br /> 2. `I't6e Re ort/log for the previous month available,and has it been reviewed by the <br /> Is the Alarm History' P <br /> j}�c ated UST ,tarot? (Atlaeh a co r o the alarm histo re oWlo to this lnspecfrc�n form.) 3 (p <br /> 4 Has each alarm for the revious month been res onded to a ro riatele�—_ to <br /> UST SYSTEM INSPECTION 00 <br /> Are tank top containment sumps free of water,debris,and hazardous substance? A'ore:Jtrhe an •er to item s,+ns }es sz,P 0 <br /> 1 to)tem 6 Sumps"'hem an alarm has.occas),(,nr the past month must Tie inspected if a quatifted service technician has nor responded ra and <br /> i !,addnssed the cattle o the a/nrm.Pocumentanon yen +�n a ra mate service should he attached to this re rt ,. (�D <br /> Yes Noy, <br /> YesN I <br /> Sump Location: Sump Location: It j :3i <br /> Surra Location: I Li I LiSum Location �)i Q <br /> & Are sdl buckets(containment structures)free of water,debris,and hazardous substance'? :. <br /> Yes No N/A (U <br /> Yes 1 No NIA - <br /> Tank 1 ID r f z ' ❑ ! Tank 4 ID <br /> Tata 2 ID- f f r c p t ❑ Tank 5 ID- <br /> 1 Tank 3 ID- Tank 6 ID- J ❑ <br /> Are under-dis enser containment areas free of water,debris,and hazardous substance? <br /> Yes No NLA Yes No N/A <br /> Dis enser-1, ❑ Dispenser-9/10 ❑ <br /> Dispenser-3,14 M Dispenser-11/12 <br /> Dispenser-5,16 ❑ Dispenser-13/14 <br /> Dispenser-7/8 0 ' Dis enser-15%16 - <br /> i <br /> 8. Leak detection is` ro erl located within under-dis 3enser containment. _ <br /> Yes No N/A Yes No rN/A <br /> Dispenser-L"2I El 0-FDispenser-9/1 o <br /> l Dispenser-3/4 <br /> ❑ I Dispenser-1112 _ <br /> Dispenser 516 ( ❑ Dispenser-13/14 ❑ ❑ <br /> I <br /> -� P ''8 I Q ❑ ❑ `II �isPenset-)Si16 _ i ❑ i 0 �` <br /> PAPERWORK INSPECTION Yes No N/A Date Done <br /> 9. 1 Momtorin System Certification was completed within the past 12 months? <br /> 16. Line Leak Detectors were testedlcertified within the past 12 months? <br /> 11. j S ill bucket('containment structure)testing com leted within the alt 12 months? 1 <br /> 12• Line it tress testing completed within the required time frame? <br /> 13, ' Sectin containment tests completed within the),(,aired time frame? _ ❑ <br /> 14. Enhanced Leak Detection completed within the re cared time frame? <br /> 15. 'Dtherre uuti <br /> ed testin maintenance was completed within re uired me fiame? (I istlestfmainrenance nems a nw <br /> Describe I est/Maintenance: -- <br /> := escrifse,Test/Maintenaince: <br /> Yes No' NI <br /> FACILITY EMPLOYEE <br /> TRAINING _. <br /> 16. <br /> Have all lash �mdyj y _s received the),quit,(,on the job training within th y? _ <br /> _.. w <br /> 1 e Hae allacilit em to eel hired within the alt 3L1 da's received the r aired on-the-ob tramm .? <br /> o -Explain any"No"answer;in the"Comments"scctictn° the following Page Whose issues require corrective action from <br /> the US l own""ciperator. <br /> C?t-967..12 vrzrros <br /> �w�w,uoidocs.org (D <br /> 0 <br /> O <br /> cQ � <br /> N � <br /> N <br /> O <br /> O UI <br /> -' N <br /> 01 N <br /> CO <br />