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1 <br /> Designated Underground Storage Tank (UST) Operator <br /> Monthly Visual Inspection Checklist <br /> nNaimne:e:ConocoPhMi s Site#2705445 Date:ress: 1206 E.March Lane <br /> onZi ST O era[or Conductin the Ins ection:Julie Leel Code Council Certification#:5248777-U2/14/2008 <br /> Phone:(5l0)245-5218 <br /> 4+ <br /> Y=Yes,N=No,NA=NotAnillcable <br /> Item <br /> MONITORING PANEL/ALARM HISTORY Y N I NA <br /> I Monitorin s stem is owered on and in proper operating mode. x <br /> 2 Monitorin s stem is not currently showing any alarms or wamin s. x <br /> 3 Alarm history report/log for the previous month is available,and has been reviewed by the x <br /> Desi ated UST erator. Attach a cgj of the alarm hislog report/logreport1log to this form i available. x <br /> 4 Each alarm for the revious month has been responded to aro natel . <br /> 5 Sensors located in tank-to containment sum shave not alarmed in the past month. x <br /> Sa _ List all tank-top sumps where alarms occurred in the past month: <br /> N/A <br /> Note:Sumps where an alarm has occurred in the past month must be inspected unless a qualified service technician responded to,and <br /> properly addressed,the cause of the alarm.Attach documentation verifying appropriate service to this report. <br /> / sum inspectionsreuired,record in item 6,below. <br /> UST SYSTEM INSPECTION <br /> 6 Tank-top containment sumps are free of water,debris,and hazardous substance. Sensors are located properly. <br /> Note:Visual inspection o sum s is not re aired in su s where an alarm has occurred in the pass month or which there is no service record <br /> Y N ? <br /> Sum Location: Sum Location: r <br /> Sum Location: <br /> Sum Location: " <br /> Sum Location: Sump Location: <br /> 7 S ill containment structures are free of water,debris,and hazardous substance. Y N NA <br /> Y N NA <br /> Tank I—Contents:87 x I Tank 3—Contents:91 x <br /> Tank 2—Contents:Diesel x I Tank 4—Contents: <br /> 8 Under-dis enser containment areas are free of water,debris,and hazardous substance. Sensors are located rN erl NA <br /> Y N NA <br /> Dis enser 1/2 x Dis eraser 7/8 x <br /> Dis enser 3/4 x Dis enser 9/10 x <br /> Dispenser 5 x Dis enser 13 114 <br /> Dis enser 6 x Dis enser 15/16 <br /> .... r:rr.:I: ... .. . <br /> PAPERWORK INSPECTION Y N NA DATE DONE <br /> 9 Monitorin s stem certification has been com feted within ast 12 months. x 5/5/06 <br /> 10 Second a containment tests have been com feted within there aired timeframe. x 12/29/04 <br /> 11 S ill containment structurethicket)test'n was co feted within the ast ear. x 5/5/06 <br /> 12 Tank ti htness testin was co feted within re aired timeframe. x <br /> 13 Line ti mess testin was co feted within re aired timeframe. x <br /> 14 Other r wired testin maintenance was com feted within re aired timeframe. List test/maintenance items below. <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> FACILITY EMPLOYEE TRAINING YN NA <br /> 15 All facilityemployees have received the required on-the-job trainingwithin the past ear. x <br /> 16I All facility employees hired within the past 30 days have received the required on-the-job trainin . x <br /> Note: Any answer of"N"should be explained In the comment section on the following page,and will require <br /> follow-up action. <br /> Page l of 2 <br />