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UNDERGROUND STORAGE TANAYSTEM Enclosure #2 <br /> DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT <br /> Facility Name: City of Lodi Ilion Date: November 4, 2005 <br /> Facility Address: 1331 S Ham Lane City: Lodi, Ca 95242-2995 <br /> Name of Designated UST Operator Conducting Inspection: Roger D Rich <br /> international C Council Certificate NO.: 5176062-UC Expiration Date: 12/21/2006 <br /> Signature: Phone: 141) _ <br /> D <br /> N1A=Not A <br /> Item MONITORING PANEL/ALARM HISTORY Yeal No N/A <br /> 1. is the monitoring system wered on and in proM operating mode? <br /> 2. Is the monitoring stem not currently showing any leak alarms? <br /> 3. Is the Alarm History Report/log for the previous month available,and has it been reviewed by the <br /> in I# <br /> Desi hated USToperator? Attach a copy of the alarm history report1log to this inspectionform) <br /> 4. Has each alarm for the revious month been respwded to <br /> UST SYSTIs:M INSPECTION <br /> 5. Are tank-top containment sumps free of water,debris,and hazardous substance? /vote-tf the awwr to Item 4 wag"Yes,"skip <br /> to Item 6. Swvw where an alarm has oiccw ed in the pmt month must be inspected ija qual#W service technician has not responded to, and <br /> propertyaddressed the catise of the akvm.Docummiatim vera to service should be attached to this re ort. <br /> Yes No Yea No + «' <br /> S Location:S-W Fuel Island Sum Location:N-E Fuel Island <br /> Sum Location:N-W Fuel Island Sump Location:S-E Shop <br /> 6. Are spill buckets containment structures free of water,debris,and hazardous substance? <br /> Yes No N/A I Yes No N/A <br /> Tank 1 ID— 10,000 Unleaded Tank 4 ID—2,000 Waste Oil <br /> Tank 2 ID— 000 Unleaded Tank 5 ID— <br /> Tank 3 ID—5,000 Diesel 4t Tank 6 ID— <br /> R 1P.1 <br /> `� 7. Are under-dispenser containment areas free of waterf debris,and hazardous substance? <br /> Yes I No J N/A I Yes No I N/A <br /> Dispenser— 1/2Muiti Product Dispenser—9/10 <br /> Dispenser—3/4 Di ser—11/12 <br /> Dis —5/6 Dispenser—/3/14 <br /> Dispenser—7/8 Di seer— 15/16 <br /> g. Leak detection is property located within spensercontainment <br /> Yee No NIA I Yes J No I N/A <br /> Dispenser— 1/2Multi Product Dispenser—9/10 <br /> Dispenser—3/4 Dispenser—I 1/12 <br /> Di user—5/6 Dispenser— 13/14 <br /> Dispenser—7/8 Dkpenw—15/16 <br /> MEMO <br /> PAPERWORK INSPECTION Yes No N/A Date Done <br /> [12. <br /> MonitoringS stem Certification was completed within the 12 months? 10/27/2005 <br /> Line Leak Detectors were tested/certified within the 12 months? 10/27/2005 <br /> Spill bucket containment structure completed within the t 12 months? 10/2712005 <br /> Lined ess test' co leted within the uir�ed time frame? <br /> Secondary containment tests completed within the required time frame? 11/8/2005 <br /> Enhanced Leak Detection com leted within the time frame? <br /> other required testing/maintenance was completed within required time frame? (List test/maintenance items below. <br /> Describe Test/Maintenance: Tube Irate Test 10/31/2005 <br /> Describe Test/Maintenaace:Static Torque&Rotation Test I Q 10/31/2005 <br /> FACUJ"EMPLOYEE TRAMNG Yes No N/A <br /> 16. Have all <br /> facility em 10 ms received the required on-the-job training within the Past Yeg? M D E <br /> �✓ <br /> 17.THave all facility employeeshired within the past 30 days received lite uired on-the-job 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 /> www.aeido <br /> UN457-1/2 es.org 4RtittMS <br />