COMPLIANCE INFO_2014 - 2018 - Laserfiche WebLink

Home Browse Search

r . 0 UNDERGROUND STORAGE TANK SYSTEM DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT Facility Name: Flag City Chevron Inspection Date: Facility Address: 6421 Capital Ave City: Lodi Name of Designated UST Operator Conducting Inspection: Alex Jabbari International Code Council Certification No.: 6243897-UC Expiration Date: 10/3/2018 Signature. Phone: 92 - �. ) 5 389-1262 N/A=Not Applicable Item MONITORING PANEL/ALARM HISTORY Yes No N/A 1. Is the monitoring stem powered on and in proper operatingmode? 2. Is the monitoring stem not currently showing any Ieak alarms? 1:1 El 3. Is the Alarm History Report/log for the previous month available,and has it been reviewed by the 4. iDesi ated UST Operator? Attach a copy of the alarm history report/logreportliog to this inspection-form.) Has each alarm for the evious month been responded to appropriately? UST SYSTEM INSPECTION 5. Are tank-top containment sumps free of water,debris, and hazardous substance? Note.Ifthe answer to Item 4 was "Yes,"or "NA"slip 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 of the alarm.Documentation ne appropriate service should be attached to this repo No sumps alarm Yes I No Sum Location: Sum Location: Yes No Sump Location: ' Sum Location: r. 6. Ares ill buckets containment structures free of water,debris and hazardous substance? Yes No NIA Yes No N/A Tank I ID—Regular Master J= El Tank 3 UT Premium Tank 2 ID—Regular Salve I Z I L1 I Ll Tank 4 ID—Diesel 0 L1 EF 7. Are under-dispenser containment areas free of water,debris,and hazardous substance? Yes I No I N/AI Yes No N/A Dispenser— 1/2 Dispenser—9/10 7- Dispenser—3/4 0 1 Dispenser—11/12 Dispenser—5/6 LJ I Dispenser—13/14 EF Dispenser—7/8 Lj I Dispenser—15/16 8. Leak detection is properly located within under-dispenser containment. Yes No N/A1 Yes No N/A Dispenser—1/2 N El I I Dispenser—9/10 Dispenser—3/4 Z i enser—11/12 Dispenser—5/6 1 Dispenser—13/14 Disnenser—7/8 1 Lj I Dis enser—15/16 PAPERWORK INSPECTION Yes No N/A Date Done 9. Monitoring System Certification was completed within the past 12 months? ® ❑ 9/26/2016 10. Secondary containment tests completed within the required time frame? 1/20/2016 11. Spill bucket(containment structure)testing completed within the past 12 months? Z El El 9/26/2016 12. Tank tightness testing completed within the required time frame? 13. Line tightness testing completed within the required time frame? IR 15. Other required testing/maintenance was completed within required time frame? ist test/maintenancejiU/261201 Describe Test/Maintenance:Air Quality Describe Test/Maintenance: 00 FACILITY EMPLOYEE TRAINING 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 training.? Note: Explain any"No"answers in the"Comments" section on the following page. Those issues require corrective action from the UST owner/operator.