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7-Eleven Inc #17334 4501 N . Pershing Ave, Stockton <br /> Designated Underground Storage Tank(UST)Operator <br /> Monthly Visual Inspection Checklist <br /> au IV Nun.: 7.11 nJ.H Dab: 3113RO13 <br /> cdtp.Addmb'. lSPI N.PERSHING AVE N <br /> Ci :STOCxTON Zip Coda: 9m07 <br /> Ob MUST Operate Contlucbpg[be Irupection: Jmtl.D..vO <br /> I.MrRtiuRl Cod.Council on M: 8213325 Expiration Dam" trJlIDta <br /> taro: Phone. t9e9)a6ad2eO <br /> Y Yaw N�No.NA�NeI APW�bb o <br /> IYIy <br /> NA <br /> MONITORING PANEL I ALARM HIaTORV Y N Ro <br /> Moei[orina Syabm u powered M and in proper opaatina mode x <br /> 2 Monno,g; ryabm u not curtondY showma any ab Ina Or wemings. R <br /> J Alum hubry nI,;,n op9 for the Provious month is available.and has been reviewed by the I>wi®u[ed UST >. <br /> OPemmr. (Atbch.coPY of the W.hi..,reporUloe m mw form d available.) x <br /> a A <br /> S _ I Eor the Previous monN has been rapovded t approPriatelY R n <br /> 0 <br /> I—in pnk-rap covbimnev[sumps have not alarmed in the past month. H <br /> List all taNe-bP sumps where alemis omurtad in the past moven'. <br /> Nan:SrmpuwM�re mrd /ev wxrrmamm`POmnwuF am,ree,vFecrM <br /> few w�wnagIhi.na ae[ ' by^u➢Grlon rcgw�rd.reeoN nrnlw <br /> ^gear°d.dle ar ldr+almin.Anal.dowm moan venJying ap➢ro➢naw a.Ma m ➢or rl^r <br /> UST SYSTEM INSPECTION <br /> 6 Tatdr-mP aonbirlment sumps are free of water,debris.and bavardoua subamnce.w�ne�°[s ar`�l°mt�adapcoperlY. <br /> :wmar..mw.wgaam r,mlrmP,nwm,. o.ma,,..ama..,,..rwr^.vn..aaa�. Y N <br /> YY N <br /> SronPLovanon: w^ SamPLocarron: <br /> Srpnp Laindon. "" SumP Lomtion: <br /> SnrnPLocanon: " SunnPL00afl0M ww <br /> Spill oontaianevt struenaes ere free of water.debris,and himiadaus substance. Y N NA <br /> Y N NA <br /> Tank-8] x <br /> Torek-9l x <br /> S Undc-ddisspmser contauunent azeas are free of wa[u.debris,and hamrdeus substance. Sensors are located Properly. <br /> Y N NA Y N NA <br /> D6p naer-I2 x <br /> Dispenser-3/4 x <br /> Y N NA DATEDONE <br /> PAPERWORK INSYECI'ION le-lt-tJ <br /> 9 Monitoring y p p X <br /> s stem certification has been completed within as[12 months. 9-ita2 <br /> 10 x <br /> Secondary containment tests have been completed within the required timeframe. x tall-17 <br /> I 1 Spill containment structure(bucket)testing was completed within the past year. NIA <br /> X <br /> 12 Tank tightness testing was completed within required timeframe. x NIA <br /> 13 Line tightness testing was completed within required timeframe. <br /> 14 Otber required testing/maintenance was completed within required timeframe.(List test maintenance items below) <br /> x NIA <br /> TesUMainrenance: x NIA <br /> Tesirmarrnenanee: x NSA <br /> . TesUA/ointenmrce: <br /> FACILITY EMPLOYEE TRAINING Y N NA <br /> 15 x <br /> All facility employees have received the required on-the-job training within the past year. x <br /> I6 All facility empl ed withi�P�t days have received the required on-the-job training. <br /> NotC ARy Ruswv aho Id e wmmentseason on the following pR>Le,and wW Tequice toRow-up <br /> D.O report dated 3/13/13 in place of report for February 2014 <br /> Page 3 of 3 Photo taken on October 17, 2014 <br />