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Oct 16 2017 02:23PM HP FaxFlaq City Chevron 2093341873 <br />V1,01t37)Prl :201 C,nrr"-0.%'t,I <br />paR.4 y @ .. <br />�n:.I" 'YR. �4 <br />N J 0 � L017 <br />UNDERGROUND STORAGE TAN SYSTE ,y RE��T <br />DESIGNATED UST OPERATOR MONTHLY INSPEGTIO <br />Facility Name: Flag City Chevron Inspection Date: 6/8/17 <br />Facility Address: 6421 Capital Ave City: Lodi <br />Name of Designated UST Operator Conducting Inspection: Alex Jabbarl <br />International Code Council Certification No.: 5243897 -UC <br />Expiration Date: 10/3/2018 <br />Signature: flr�_ G„ ,4 <br />Phone: (925) 389-1262 <br />N/A =1 _# A--ji ha. <br />Item <br />MONITORING PANEL / ALARM HISTORY <br />Yes No N/A <br />1. <br />Is the monitoring system powered on and in proper operating mode? <br />2. <br />Is the monitoring system not current!y showing any leak alarms? <br />3. <br />Is the Alarm History Report/log for the previous month available, and has it been reviewed by the <br />Designated UST Operator? Attach a copy of the alarm history report/logreporrIlog to this ins ection orm.Ilk <br />4. <br />Has each alarm for the revious month been responded to appropriately? <br />UST SYSTEM INSPECTION <br />5. <br />Are tank -top containment sumps free of water, debris, and hazardous substance? Note: IJthe araiver to Item 4 was "Yes, "or <br />"NA" skip to Item 6. Sumps lvhere an alarm has occurred in the past month must be inspected jf a qualified service technician has not responded <br />to and properly addressed the cause of the alarm. Documentation ver! yin appropriate service should be attached to this report. <br />No sumps alarm Yes No <br />Yes I No <br />Sump Location: 0 1 El <br />Sump Location: <br />I El I El <br />Sump Location: <br />Sump Location: <br />6. <br />Ares ill buckets containment structures free of water, debris, and hazardous substance? <br />Yes No N/A <br />Yes No N/A <br />Tank 1 ID - Regular Master El Tank 3 ID - Premium <br />Tank 2 ID - Regular Salve M i LJ I = Tank 4 ID - Diesel <br />7. <br />Are under -dip enser containment areas free of water, debris;'` nd hazardous substance? <br />Yes I No N/AI <br />Yes No N/A <br />Dispenser - 1/2 0 Dispenser - 9/10 <br />Dispenser - 3/4 0 El I Dispenser - 11/12 <br />Dispenser - 5/6 EE Lj I Dispenser - 13/14 <br />Dispenser - 7/8 0 El I El I Dispenser - 15/16 <br />8. <br />Leak detection is properly located within under -dispenser containment. <br />Yes I No IN/AI <br />Yes No N/A <br />Dispenser - 1/2 Dispenser - 9/10 <br />Dispenser - 3/4 Dispenser - 11/12 <br />El 0 <br />Dispenser - 5/6 0 F El I Dispenser - 13/14 <br />El El <br />Dispenser - 7/8 Dispenser - 15/16 <br />PAPERWORK INSPECTION Yes No N/A <br />Date Done <br />9. <br />Monitoring System Certification was completed within the past 12 months? Z10 El <br />9/26(2016 <br />10. <br />Secondary containment tests completed within the required time frame? <br />1 /20/2016 <br />11. <br />Spill bucket (containment structure) testing completed within the past 12 months? <br />9/26/2016 <br />12. <br />Tank tightness testing completed within the required time frame? <br />13. <br />Line tightness testing completed within the required time frame? <br />15. <br />Other required testis maintenance was completed within rec wired time frame? List test/maintenance items below. <br />Describe Test/Maintenance: Air Quality9/26/2016 <br />Describe Test/Maintenance: <br />FACILITY EMPLOYEE TRAINING <br />Yes No <br />N/A <br />16. <br />Have all facility employees received the required on-the-job training within the past ear? <br />17. <br />Have all facility employees hired within the past 30 days received the required on-the-job training.? <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 />