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Designated Underground Storage Tank (UE <br /> Monthly Visual Inspection Checi <br /> Facilit Name: <br /> Facilit Address: JUL 2 4 201Zi Code: 95 <br /> Cit : Stockton CA. <br /> Desi nated UST O erator Conduct' the inspection:Mark R.Fairbanks,Fairbanks EN./,,.� 1u <br /> International ode o ncil Certific tion#: 5243795-UC Expiration D 11 L <br /> Phone: 209 <br /> Si nature: Y=Yes,N=Ao,NA=Noon n�aF <br /> MONTLOI2ING PANEL/ALARM HISTORY Y N <br /> Item NA <br /> 1 Monitorin s stem is powered on and in proper o2erating mode. <br /> 2 Monitorin s stem is not currentl showina an alarms or warnin s. <br /> 3 Alarm history report/log forthe previous month is available, and has been reviewed by the <br /> Desi nated UST O erator. Attach a co Y of the alarm history reeoEY09 to thisLo i available. <br /> 4 Each alarm for the previous month has been res onded to ar. ro riatel . x <br /> 5 Sensors located in tank-to containment sumps have not alarmed in the ast onth. Hnr, tan / ' <br /> 5a List all tank-top sumps where alarms occurred in the past month: <br /> eti q nn. dC I Y <br /> Nater Sumps here alarm hos occurred in the past month mus be inspected unless aqua ified service to nician responded to,and SV <br /> properly addressed,the cause of the alarm.Attach documentation verging appropriate service to this report. <br /> I sum ins ec6on is re aired,record results in item 6,below. ,. <br /> UST SYSTEM INSPECTION <br /> 6 T containment sumps are free of water, debris,and hazardous substance. Sensors are located properly. <br /> Note:Visual inspection o sums is on re ired in sum s where an alarm has occurred in the vast month for which there is no servicNrecord. <br /> Y N <br /> Sum Location:TJNL Re alar Sum Locati -1k 2 <br /> on: <br /> onT <br /> Sum Location: UNL Su reme Sum Locati : -ASum Location: <br /> Sum Location.Diesel <br /> 7 S ill containment structures are free of water,debris, a: hazardous substance. Y N NA <br /> Tank 1—Contents:UNL Re lar Tank 3—Contents:Diesel <br /> Tank 2—Contents:UNL Su reme Tank 4—Contents: <br /> 8 Under-dis enser containment areas are free of water, debris and hazardous substance. Sensors are locateded <br /> rN NA <br /> Di venser 1/2 Di enser 9/10 <br /> Di enser 3/4 Di enser II/12 <br /> Di enser 5/6 Di nser 13/14 <br /> Dis Bruer 7/8 Di enser I S/16 <br /> PAPERWORK INSPECTION Y N NA DATE DONE <br /> 9 Monitorin s stem certification has been con leted within ast 12 months. <br /> 10 Second containment tests have been com leted within the required timeframe. - <br /> 11 S ill containment structure bucket testin was com leted within the ast ear. _ a <br /> 12 Tank ti htness testing was completed within re uired timeframe. <br /> 13 Line ti htness testing was com leted within required timeframe. <br /> 14 Other re uired testin maintenance was completed within re uired timeframe. (List test/maintenance items below. <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> FACILITY EMPLOYEE TRAINING Y N NA <br /> 15 All facilit em to ees have received the re uired on-the- ob training within the ast ear. <br /> 16 All facili em to ees hired with n the ast 30 da shave received the re uired on-the-'ob trainin . <br /> Note: Any answer of"N"should be explained in the comment section on the followang page,and will require <br /> a follow-up action. <br /> Page 1 of 2 November 2004 <br />