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UNDERGROUND STORAGE TANK <br /> DESIGNATED UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPORT (Page 1 of 2) <br /> lam NNOMMUMM� <br /> I . FACILITY INFORMATION <br /> CERS ID 7Date0of Designated UST Operator Inspection <br /> 10184725 2/ 19 <br /> Business Name (Same as Facility Name or DBA-Doing Business As.) <br /> West Valley Auto Service LLC <br /> Business Site Address City ZIP Code <br /> 2615 W Grant Line RD <br /> Tracy 195304 <br /> Il. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Name of Designated UST Operator (Print as shown on the /CC Certification.) Phone # <br /> Rick Branchini (925) 699 - 1396 Ext, <br /> ICC Certification # ICC Certification Expiration Date <br /> 8164986 06/21 /2020 <br /> III . COMPLIANCE ISSUES <br /> All answer of "M' or "Win sections Vll through XI must be explained in this section and may require follow-up action. <br /> 1 . All Functions Normal at time of inspection <br /> 2 . E- 1 Comn Alarm 5/20 , 5/27 , 5/28 Self Corrected <br /> 3 . Q - 1 PLLD Shutdown 5/ 16/ 19 Inspection by EHD <br /> 4. L-7 STP Sump Diesel 5/ 18/ 19 <br /> 5. Q-3 PLLD Shutdown 5/ 18/ 19 <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> 11 . Sections VII thru XLL Continuous in tank leak detection method TLS-350 PLLD line testing See Alarm <br /> 12 . history report . *Continuous in tank leak detection & Line tightness PLLD testing continuous <br /> IV. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING THIS INSPECTION <br /> I hereby certify that the visual inspection was performed in full compliance with California Code of Regulations, title 23, <br /> division 3, chapter 16, section 2716 and all the information provided herein is accurate. <br /> Designated UST Operator Signature <br /> V. OWNER / OP BATOR DESCAIPTION OF FOLLOW-UP ACTIONS <br /> All issue listed in section Ill above, must have a description of the follow-up action taken, or to be taken, to correct the issue on the number line that <br /> corresponds with the number line the compliance issue is listed above in section ill. <br /> 1 . Overfill protection recertified and completed 3/25/19 L-2 Fill Sump see report <br /> 2. Spill bucket Testing Performed 4/ 1 /19, 5/ 16/ 19 5 gallon capacity 91 and Diesel ( Report within) NFA <br /> 3 . S13-989 Testing UDC 1 /2 retested and passed 5/16/ 19 . . See notes within this report <br /> 4. Deflector plates installed dispensers 1 through 12 witnessed and report within NFA <br /> 5. L-7 STP Sump 5/18/19 Q-3 Water is sump Water removed 5/19/ 19 same as L-9 Checked seals <br /> L-9 5/ 19 Vent sump Working on water intrusion and water deflection <br /> 6 . <br /> 7. <br /> 8. <br /> 9 . <br /> 10 . <br /> 11 . <br /> 12 . <br /> VI . OWNER / OPERATOR ACKNOWLEDGMENT OF COMPLIANCE ISSUES <br /> I have reviewed section III "COMPLIANCE ISSUES" and provided a description in section V, of the action taken or to be taken <br /> to correct the issues discovered. <br /> Name of UST Owner/Operator (Print) UST Owner/Operator Signature Date Signed <br /> Hakimi Was Manager 06/02/ 19 <br /> CERS = California Environmental Repo rttng System ID = Identification UST — Undemround stAraae tank, ICC — International Code Council <br />[' <br />