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Super Store Industries 16888 McKinley Avenue, Lathrop, CA <br /> 1 Designated Underground Storage Tank(UST)operator <br /> Monthly Visual Inspection Checklist <br /> Fac ' Nom. <br /> - <br /> F <br /> C. Code S <br /> i DesiUSr the 'oa <br /> j€ <br /> scode Cvtification t m' Date: / / .2c/Si - I PhD= -1i(-Y C 7�t-Gc 9 <br /> Y=Y N= tU=Nst <br /> M <br /> MONITORING PANEL/ALARM HISTORY Y N NA <br /> steiMo ' is eot s. . ig my alarms or warnings. <br /> 3 Ah®history rgxwtAog for the previous mouth is available,and has been reviewed by the <br /> Designated UST Operator. Attaeh a copy ofthe alarm Inst to this mer ifavadab& <br /> 4 Each alarm for the previous mouth has bear respormlod to appropriately. <br /> 5 Sensors located an tmk4op cwmivmeof surnps have not alarmed an the past month. <br /> 5a List all rarrk4op amqu where alarms occurred in the part month: 4� <br /> Nate:sups.te.an semen am amend a tle pmt s.asrs svm k Empasm rodeo a gdyidsvaoe axtrrraAranmded 4 sal <br /> propvfy adai®d tle tart 60k dust An h dximanraor ienfjog mrlta b tlirreporL <br /> u reqwre4 recordrwAn in ons 6.below. <br /> USP SYSTEM INSPECTION <br /> 6 Tank-top containment murips are free of water,debris,anal haardow substeme. Sensors are located property. (1 <br /> xdc Vtad a mq,,ed a whew err almw Mraccuredd de sesvA rihLlbeis wo arras rand //�, <br /> Y N Y N 1 <br /> j S Location S Locarion: 64 IAI <br /> S location S Location: <br /> I - SWHV Location: <br /> ' 7 Spill containment structures are fix ofand headous substance— <br /> MY <br /> ubstance. <br /> MN NA Y I N I NA <br /> Tank 1-Cm W&. Tack 3-Contents: O/L- <br /> Tank 2- I lTank,I-Conernty: I L 1 <br /> 8 Under cont inm®t areas are fix of water and haardas subshux. Staves sm located mooeriv. D <br /> Y I N INA I nNN Fi <br /> pirpowerl/2 9/10 l <br /> ptypenser 3/4 11/12 <br /> pirpenser 5/6 a/3/t4 t <br /> Ip&penw,718 I I l,,fDispenw15116 <br /> I PAPERWORK INSPECTION YIN NA DAZE DONS <br /> 1 q A4onjtontig astern ceMDCO ion has baa cum leted within pan 12 rn m <br /> ti to tammea[Iota have bcen lelod within the rewhyd t®e6ntma '2Q iS <br /> 1 I - �iament stntctue--- _wast.lefed within the ear. <br /> Item 4 is checked "Y" for "yes" when there was no alarm during the previous month and Item 5 is not checked off. <br /> Photo taken on: 10-7-2016 <br />