Laserfiche WebLink
v, _U o v_) <br /> O (u m <br /> D <br /> o - 00 o Q, <br /> w Z <br /> O _... on <br /> YSTF m in <br /> Z UNDERGROUNll 8't't)RAGF;"i°�;;�K Sp <br /> �NATED UST OPERATOR MC3NTIILY SNS cc-F,; kip m <br /> O <br /> n �� Inspection tate: /j N <br /> Name S 1�- �-- City: _. -"_ p (� <br /> 2 racitity �� j- ! o ITl <br /> d c. - / <br /> Foci A erator Conducting Inspection: Douglas Nunn �` N <br /> esignated LIST Op _-.._ <br /> Name of D 5238716 _ Expiration n O U) <br /> e Council Certification No.: _ Date:-'—�- <br /> 7125/2019 (D Co <br /> -irrational Cod Phone: <br /> ature: (510)894-1401 ext O U) <br /> m <br /> MONITORING PANEL/ALARM HISTORY NIA.-ofA 00 <br /> Yesi No 4iae to 77 <br /> monitorin s stempowered on and in proper <br /> operating mode? O <br /> 1 Is the <br /> ing system not current) showin an leak alarms" "— N/A 0 � <br /> ls-th-?'-ttoHistory Report/109 for the previous month available,and has it been reviewed by the U) <br /> j;s the Alarm rator. (Attach a co o the alarm historyre ort/!v to thle Ins ecrion <br /> ?sienated UST O __ nm O <br /> NZS each zlann for the revtous month been responded to a ro nate/ ? E <br /> -- <br /> ------` UST SYSTEM INSPECTION - <br /> tank-top containment sumps free of water,debris,and hazardous ubsstance� hn¢ rflhe"�-on, __4 �i <br /> rs-Surnl+.t"here an alarm has occurred in/he post manrh must be inspected r a uatr re t rervlee lecbrrcran has Oat � <br /> <s-d the cause atthealam Documentat+on ren vn�a ro marc servrce_+hvutd be aita:.ryc� <br /> ssi�r_ Yes No An CD <br /> 0 Sump Location: --- Yes No (p <br /> 1.0cation: wmp I ovation: ~" - U <br /> S <br /> Location: ❑ ' F 1 <br /> til buckets(containment structures?free of water.debris,and hazardous substance? — - O <br /> Yes No N/A -- _ <br /> 1 ID- CL <br /> 1 ❑ 1 ❑ Tank 4 I D <br /> Yes i No NiA � <br /> Zvi ❑ Tank 5 ID CDD <br /> Tack 2 JD- Tank 6 ID- CL <br /> Tank,3ID- �/ . -4� <br /> Are under-dis enser containment areas free of water,debris,and hazardous substance? O <br /> Yes No I N/A Yes No NIA <br /> ❑ Dispenser-9/10 <br /> "Dis enser-1/2 ❑ ❑ Dispenser-11112 M <br /> Dis enser-3/4 <br /> Dis enser-5/6 Dispenser-13/14 <br /> Dis enser-7/8 ❑ ❑ Dis enser- 5/16 <br /> 8. Leak detection is properly located within under-dis enser containment. <br /> Yes No N/A I Yes No NIA <br /> Dis enser-1/2 ❑ Dispenser­9/10 <br /> Dis enser-3/4 ❑ Dispenser-11/12 <br /> Dis enser-5/6 ® ❑ Dispenser-13/14 _ <br /> Dis enser-7/8 ❑ ❑ Dispen ar-li!16 <br /> No N/A Date Done <br /> PAPERWORK INSPECTION Yes_ <br /> 9. Monitoring S stem Certification was completed within the past 12 months? Z� r <br /> ak Detectors were tested/certified within the past 12 months'? <br /> ket(containment structure)testing completed within the past 12 months? <br /> tress testing completed within the required time frame? --+ +41� C,r <br /> containment tests completed within the re aired time frame _ <br /> arced Leak Detection completed within the re uired time frame?~_� lox-./ <br /> er re aired testing/maintenance was completed within re itir d frau e' FLlst tt°st'�t+air:r7°-'c`'tena nr <br /> `1Describe Test/h4aintcnance: _— �— i Yes l No .N <br /> _ FACILITY EMPLOYEE TRAININc� <br /> I I6; s Flaue all tacilit em to ees received the re aired on the=ob traininowathtn the ash ear? II <br /> 1�- Have all faeili em to ees hired within the ast 30 da s received th a7eauE Tho ehssueb equine corrective action from <br /> Note: ExPlain any"No"answers in the"Comments"section on the followinb P gaOs <br /> m <br /> the UST owner/operator. 0 <br /> UN-057-1/2 O <br /> HM w.unidocs.nrK <br /> Q. <br /> � D <br /> � 4# <br /> (D <br /> W X17 <br /> O <br /> O on <br /> IV <br /> .A <br /> 00 <br />