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u;CEIVED <br /> Designated Underground Storage Tank (UST) Operat r <br /> Monthly Visual Inspection Checklist 19 20€4 <br /> Facility Name: 7-1132190 Date: 4115/2014 <br /> Facility Address: 4943 S.STATE RT.99 ENVIRONMENTAL <br /> City:STOCKTON Zip Code: 95215 HEALTH DEPARTMENT <br /> Designated UST Operator Conducting,the Inspection: Justin Downs <br /> International Code C 1 Certification 4: 8232225 Expiration Date: 113/2016 <br /> Signature: 1111f Phone: (949)460-5200 <br /> Y-Yes,N-No,NA-Not Applicable <br /> ItemMONITORING PANEL/ALARM HISTORY tY N NA <br /> 1 M itoring System is powered on and in proper operating mode 2 Monitoring system is not currently showing any alarms or warnings. <br /> 3 Alarm history report/log for the previous month is available,and has been reviewed by the Designated UST X <br /> Operator. (Attach a copy of the alarm history report/log to this form if available.) <br /> 4 Each alarm for the previous month has been responded to appropriately. X <br /> 5 Sensors located in tank-top containment sumps have not alarmed in the past month. X <br /> Sa - List all tank-top sumps where alarms occurred in the past month: <br /> Note:Sumps where an alarm has occurred in the past month must be inspected unless a qualified service technician responded to,and properly <br /> addressed.the cause of the alarm.Attach documentation verifying appropriate service to this report.Jf sump inspection is required,record results <br /> in item 6,belaw. <br /> UST SYSTEM INSPECTION <br /> 6 Tank-top containment sumps are free of water,debris,and hazardous substance. Sensors arc located properly. <br /> Note:Yiw...r ixvpectenn rf.rumps is nnl�reyuirrd re.rumps where urt alurnr toes ucr:unrrd in ehrpurt mouth jrx wkkh there i.r nn.rrrvue mrrd <br /> - - Y N Y N <br /> Sump Location: N'^ Sump Location: N/A <br /> Sump Location: NrA Sump location: N/A <br /> ! Sump Location: NA Sump Location: NIA <br /> 7 Spill containment structures are free of water,debris,and hazardous substance. <br /> --- Y N NA Y N NA <br /> Tank-87 X Tank-41 X <br /> Tank-89 IX <br /> 8 Under-dispenser containment areas are free of water,debris,and hazardous substance. Sensors are located properly. <br /> Y N I NA Y N NA <br /> Dispenser-112 X Dispenser-9/10 X <br /> Dispenser-314 X Dispenser-11/12 X <br /> Dispenser-516 X <br /> Dispenser-718 X <br /> PAPERWORK INSPECTION Y N NA DATE DONE <br /> 9 Monitoring system certification has been completed within past 12 months. X . .7-13 <br /> 10 Smondary containment tests have been completed within the required timeframe. X t7rtA-12 <br /> 11 Spill containment structure(bucket)testing was completed within the past year. X <br /> 12 "rank tightness testing was completed within required timeframe. X NIA <br /> 13 Line tightness testing was completed within required timeframe. X NIA <br /> 14 Other required testing/maintenance was completed within required timeframe.(List test/maintenanee items below) <br /> Test/Maintenance: X NIA <br /> TestlMaintettance: X NIA <br /> Test/Maintenance.: X NIA <br /> FACILITY EMPLOYEE TRAINING Y N NA <br /> 5 All facility employees have received the required on-the-job training within the past year. X <br /> 16 All facility employees hired within the past 30 days have received the required on-the-job training. X <br /> Note: Any answer of i°N"should be explained in the comment section out the following page,and will require follow-up <br /> action. <br /> Page 1 of 2 <br />