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UNDERGROUND STORAGE TANK SYSTEM DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT FacilityName: Cityof Lodi Inspection Date: November 28, 2007 Facility Address: 1331 S. Ham Lane City: Lodi Name of Designated UST Operator Conducting Inspection: Dennis Callahan International Code Council Certification No.: 1004653-UC Expiration Date: 12/20/2008 Signature: Phone: (209) 333-6800 ext.2690 N/A—Not A pfica c Item MONITORING PANEL/ALARM HISTORY YesFN �+/ 1. Is the monitoring system powered on and in proper operating mode? � ❑ 2 Is the monitoring system not currently showing any leak alarms? ® ❑[aDesignated s the Alarm History Report/log for the previous month available,and has it been reviewed by the ® ❑UST Operator? (Attach a copy of the alarm history report/lo to this inspectionform.) Has each alarm for the previous month been responded to appropriately? ❑ ❑ ❑ UST SYSTEM INSPECTION 5. Are tank-top containment sumps free of water,debris,and hazardous substance? Note:IJthe answer to Item 4 was"Yes,"skip o Item 6. tirrrrrps where cur uRnvn Iro.c occurred ur nce post rnontir nn+.cr h<+nspecrcd!!a gncthlied sen+ce recdnuran hos not responded to,and ro erl addressed,t�cause=sland� mentation veri in appropriate service should be attached to this re rt. Yes No Yes No Sump Location: ® ❑ Sump Location:N/E Fuel Island ® ❑ Sump Location: N/W Fuel Island I ® I LJ I Sump Location: S/E Shop ® ❑ 6. Are spill buckets(containment structures) free of water,debris,and hazardous substance? Yes No N/A Yes No N/A Tank I ID- 10,000 Unleaded ® ❑ 0 Tank 4 ID- Waste Oil ❑ ❑ Tank 2 ID- 2,000 Unleaded ® ❑ ❑ Tank 5 ID- ❑ ❑ ❑ i Tank 3 ID- 5,000 Diesel ❑ ❑ Tank 6 ID- ❑ ❑ ❑ 7. Are under-dispenser containment areas free of water,debris,and hazardous substance? Yes No N/A Yes No N/A Dispenser- 1/2 Multi-product ® ❑ = Dispenser- ❑ ❑ ❑ Dispenser- ❑ ❑ ❑ Dispenser- ❑ ❑ ❑ Dispenser- ❑ ❑ ❑ Dispenser- ❑ ❑ ❑ Dispenser- ❑ ❑ Dispenser- ❑ ❑ ❑ 8. Leak detection is properly located within under-dispenser containment. Yes No N/A t No N/A Dispenser- 1/2 Multi-product ® F-1 El Dispenser- Li F]Dispenser- ❑ ❑ ❑ Dispenser- ❑ ❑Dispenser- ❑ ❑ ❑ Dispenser- ❑ ❑ II Dispenser- ❑ ❑ ❑ Dispenser- ❑ ❑ ❑ PAPERWORK INSPECTION Yes No N/A Date Done 9. Monitoring System Certification was completed within the past 12 months? ® ❑ ❑ 9/27/2007 10. Line Leak Detectors were tested/certified within the past 12 months? ® ❑ ❑ 9/27/2007 11. Spill bucket(containment structure)testing completed within the past 12 months? ® ❑ ❑ 9/27/2007 12. Line tightness testing completed within the required time frame? ® I Li ❑ 2/13/2007 '! 13. Secondary containment tests completed within the required time frame? -p❑ 10/5/2007= 4esei� 14. Enhanced Leak Detection completed within the required time frame? ❑ ❑ ® it 8 OE 15. Other required testing/maintenance was completed within required time frame? (List test/maintenance items below.) Describe Test/Maintenance: Drop Tube Integrity Test-every 3 yrs ® ❑ _❑ 1 10/31/2005 11 Describe Test/Maintenance: Static Torque&Rotation Test-every 3 yrs TM I ❑ I ❑ 10/31/2005 FACILITY EMPLOYEE TRAINING Yes No N/A 16. Have all facility employees received the required on-the-job training within the past year? ® ❑ ❑ 17. Have all facility employees hired within the past 30 days received the required on-the-job training.? ❑ ® ❑ Note: Explain any"No"answers in the"Comments"section on the following page.Those issues require corrective action from the UST owner/operator. UN-057-112 www.unidoes.org 9/26/05