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UNDERGROUND STORAGE TANK SYSTEM DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT aci ityName: City of Lodi Inspection Date: September 26, 2012 Facility Address: 1331 S. Ham Lane City: Lodi Name of Designated UST Operator Conducting Inspection: Randy Laney International Code Council Certification No.: 5317552 Expiration Date: 7/19/2013 Signature: Phone: / (209) 333-6800 ext, 2684 _ N/A=Not Applicable Item MONITORING PANEL/ALARM HISTORY Yes No N/A I. Is the in nitoring system powered on and in proper operating mode? ® ❑ ❑ 2. Is the monitoring system not currently showing any leak alarms? ® ❑ ❑ 3. Is the Alarm History Report/log for the previous month available,and has it been reviewed by the ® ❑ Designated USTOperator? (Attach a copy o the alarm history report/log to this inspectionform.) 4. 1 Has each alann 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:If the answer to Item 4 was "Yes,"skip to Item 6. Sumps where an alarm has occurred in the past month must be inspected if a qualified service technician has not responded to, and properly addressed,the cause o the alarm.Documentation verifying ro riate service should be attached to this report. Yes No 1,3 Yes No Sump Location:S/W Fuel Island ® ❑ Sump Location:N/E Fuel Island ® ❑ Sum Location:N/W Fuel Island ® ElSum Location: El ❑ 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 ® ❑ ❑ Tank 4 ID— :a-LEI ❑ Tank 2 ID— 2,000 Unleaded ® ❑ ❑ Tank 5 ID— ❑ ❑ ❑ Tank 3 ID— 5,000 Diesel ® I ❑ I Tank 6 ID— ❑ ❑ ❑ 7. Are under-dispenser containment areas free of water,debris,and hazardous substance? Yes I No I N/A Yes NoPN�/A Dispenser—1/2 Multi-product ® ❑ Dispenser— ❑ Dispenser— Dispenser— F-1 ❑ Dispenser— ❑ ❑ Dispenser El ❑ Dispenser— ❑ Dispenser— ❑ ❑ ❑ 8. Leak detection is properly located within under-dispenser containment. ............... Yes No N/A Yes No N/A Dispenser— 1/2 Multi-product ® ❑ ❑ Dispenser— ❑ Dispenser— F-1 ❑ ❑ Dis enser— F1El Dispenser— ❑ ❑ ❑ Dispenser— ❑ Dispenser— ❑ ❑ ❑ Dispenser— ❑ ❑ ❑ PAPERWORK INSPECTION Yes No N/A Date Done 9. Monitoring System Certification was completed within the past 12 months? ® ❑ ❑ 9/16/2011 10. Line Leak Detectors were tested/certified within the past 12 months? __9_== 9/16/2011 11. Spill bucket(containment structure)testing completed within the past 12 months? ® ❑ 9/16/2011 12. Line tightness testing completed within the required time frame? i ❑ ❑ 13. Secondary containment tests completed within the required time frame? ® ❑ ❑ 10/13/2011 14. Enhanced Leak Detection completed within the required time flame? 1 ❑ ❑ 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 ® ❑ ❑ 4/24/2012 Describe Test/Maintenance: Static Torque&Rotation Test-every 3 yrs ® ❑ I ❑ 1 4/24/2012 --- FACILITY EMPLOYEE TRAINING Yes No N/A 16. Have all facility employees received the required on-the-job training within the past ear? ® ❑ ❑ 17. Have all facility employees hired within the past 30 days received the required on-the-job train in .? ❑ ❑ UN-057-1/3 wNyw.unidocs.org 9/26/05