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Rpr 30 07 08: 30a p, 4 <br /> UNDERGROUND STORAGE TANK SYSTEM <br /> DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT <br /> Facility Name: Jahant Food &Liquor Inspection Drte: <br /> Facility Address: 24323 Hwy 99 City: Acampo,CA 95270 <br /> Name of Designated UST Operator Conducting Inspection: <br /> [n[arnationa de Council Certification No,: u C Expiration Date: <br /> Signal <br /> Phone: (916) 371-2380 ext_ <br /> N/A=Not A icabla <br /> R4Has <br /> MONITORING PANEL/ALARM HISTORY Yes No NIA <br /> the smnitorht s <br /> :ICM <br /> wend oa and in ro r operating mode? <br /> me monitorin s slcm not currentl showin an leak alarms? <br /> the Alarm History Report/10g for the previous month available,and has it been raviewetl by the <br /> esi rated UST O tor? Attach a co o rhe alarm histo- re rlfo to this int erion ornt. <br /> each alarm 2'or the eviow month been Ccs onded to ara rioter ? <br /> N UST SYSTEM INSPECTION <br /> S. Are tank-top containment sumps free of water,debris,and hazardous substance? Nate:If rhe answer to Item v was"ver,-skip <br /> to Item 6.Somas where an alarm bar acearred W are parr month teas[be irupeeeed if a 4ardykd seraice wrimicum has nee responded W, and <br /> Pmpwty addresfzd the Cnue afrhe aiorac Doarareraarion yt,4II aPPIIaw muses Chadd bearraehed ro <br /> Yd:. c <br /> aNo <br /> et <br /> NoSum Location: S oion: <br /> SLoon:Sum Location: ❑ xr ca ❑ <br /> ,•:: .: <br /> 6. Ares ill buckets containment structures free of water,debris,and hazardous substance? <br /> Yes No N/A I Yes No N/A <br /> Tank 1 ID—87 W Tank 4 ID—DSL <br /> Tank 2 ID—89 1'attk 5 ID— <br /> Tank 3 ID—91 Tank 6 ED— <br /> Arc under-dis a&wz conninment areas free of water,debris,and hazardous substance? <br /> Yes No N/A Yes No N/A <br /> Di eraser-1!2 <br /> D' user_3/4 ❑ Dis —9/10 ❑ <br /> Dis eraser—5/6 Dispenser-11/12 <br /> Dis sat—7/8 D rwr-13/14 <br /> 8. Leak detection is r err located within under-dis user coLJ I n winm rat penser—15/16 <br /> Dis eraser—3/3 <br /> Pts No N/A Yes No N/A <br /> Dis —9/10 <br /> Dis •n-r-314 Ds nser-11112 <br /> Dis ensu—516 Dia eraser—13/14 <br /> Dis ettser-718 Dis Cesar-15/16Li <br /> El <br /> PAPERWORK INSPECTION <br /> 9. Monitorin S stem Ccrtiliegtuou was cam lad within the est 12 mond'o <br /> were Yes No N!A Nate Done <br /> 10. Line Leak Detectors tes <br /> tc4/mrti6ed within the past 12 months? <br /> 11. S ill bucket containment structure les ' com leted within the <br /> 12 months? <br /> 12. Line ti mesa lestin sore leted within the re uired time frame? 5/t O6 <br /> 13. Second ar containment tests CIOMPLUtsd within the required time frame? ❑ <br /> 14. Enhanced Leak Detection completed within the re aired time fraena? ❑ 9/27/05 <br /> 15. Other re aired testi maintenance was co le[ed <br /> Describewithin rc aired tame frame? isr testlmaintenartee stems be[aw. <br /> Test/Main[cnance:Air Q'wtli St 27&30 <br /> Describe Tesumainhmance: ❑ 10/13/05 <br /> FACILITY EMPLOYEE TRAINING <br /> 16. Have alt facili a !o ees received the [tired on-the-' Yes No N/A <br /> 17. Have all fa 'i a ltl ees hired within dle st 30 da s received the r [»red on -'ob trainin .? <br /> Note: Explain any"No"answers in the"Comments"section on the following page.Those issues require corrective action from <br /> the UST owner/operator. <br /> UN-U57.12 <br /> www.ttnidatvoeb <br /> Y/261U5 <br /> 9R 17.R 39vd 3DN3NVIINVW Z9 05CZI:L6916 0T:91 LOOZ/LZ/40 <br />