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Site ID:1275-1 Af 16 Zed dStreet Designated Operator Galt,Ca 95632 MonthlyInspection Checklist Facility Employee Tithe pa Pa e 2 of 2 209-744-0112 Fax 209-744-0116 p All facility employees have recce cd the required on-the-job training within the past year. X All facility employees hired wnlun the past 30 days have received the required on the job training. L I IX Site:UNITED GAS Date:6-26-14 Monthly Inspection— Y N NA Date Done 3440 E MAIN Monitoring system certification(within past 12 months) X 6/27/13 Spill Bucket testing completed(within past 12 months) X 6/27/13 STOCKTON CA Leak Detector-mechanical/electronic for most sites(within past 12 months) X 6/27/13 The above are usually done together on an annual basis for local regulator. Lane A.Nimmo David A.Winkler Felix G.Ramirez Line Tightness(usually upon construction or when no positive shutdown) ❑' ® ❑ ❑ Edward 45263322 N5263373 #5273934 N5250492 Tank Tightness(Usually only after construction or when using SIR) v V_ N-e NA-not y m lk.bk Secondary containment(SB989)tests have been completed(usually every 3 years) X 6/28/13 MONITORING PANEL/ALARM HISTORY Y N NA Other ring system is powered on and in proper operating mode. X Test Mainten or maintenance completed as required List them below: poring system is not currently showing any alarms or warnings. X Test/Maintenance:AQMD X 6/27/13 Test/Maintenance: Alarm history reporUlog for the previous month is available,and has been reviewed by the Designated UST X operator. Attach a copy o the alarm history report,log to thisform i available. Test/Maintenance: Each alarm for the previous month has been responded to appropriately X PRINTOUT INCLUDED: Yes® No❑ NA❑PRINTOUT LEFT ON SITE:MBINDER UP TO DATE: Sensors located in tank-top containment sumps have not alarmed in the past month. X List all tank-top sumps where alarms occurred in the past month: Comments:sump dry all sumps. ALL SENSORS SAY 6-20.14.RELIABLE WILL DO EH TESTING SOON PER OWNER BECAUSE OF COLD START Note:Sumps where an alarm has ocv.•urred in the past month must be inspected unless a qualified service technician resp nded to,and properly addressed,the cause of the alarm Attach ik umenmtion verifying appropriate senice to this report.If sump inspection is required,record results at item 6,belaw. UST SYSTEM INSPECTION Y I N I NA I ji Tank-top containment sumps are free ofwater,debris,and hazardous substance.Sensors are located properly. Items R uirin Follow-u Actions N/A Note:Visual in etian o rim is aril reuired in mm s where an,", has accirred in the month which there is no Sump Location:87 X Sump Location: Sump Location:89 X Sump Location: Sump Location:91 X Sump Location: Sump Location: Sump Location: Sump Location: Sump Location: Spill containment structures are free of water,debris,&hazardous substance. Tank I-Regular X Tank 5- Monthly inspection must be conducted by an ICC licensed Designated Operator. Tank 2-Plus X Tank 6- Tank 3-Premium X Tank 7- A copy of this checklist must be provided to UST owner or operator,but not to State Water Resources. 4-Diesel Tank 8- r-dis nser containment free of water,debris,&hazardous substance.Sensors located properly. Designator Operator must alert the UST owner or operator of any condition discovered during the monthly Dispenser 12 X Dispenser 19/20 inspection that may require that may require follow-up action. Dispenser 3/4 X Dispenser 21 Dispenser 516 X Dispenser 2221 UST owner or operator must maintain a copy of this monthly inspection and any attachments for the previous Dispenser 7/8 X Dispenser23/22 12 months.Records must be maintained on-site or,if approved by the local agency,off-site at a readily Dispenser 9/10 Dispenser 24/23 available location. Dispenser 11/12 Dispenser 2524 ]m Dispenser 13/14 Dispenser 2625 Dispenser 15/16 Dispenser 2726 Satellite R EIVED 79 Dispenser 17/18 Dispenser 27 JUL 0 12014 ENVIRONMENTAL HEALTH DEPARTMENT