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UNDERGROUND STORAGE TANK SYSTEM DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT Facility Name: Flag City Chevron Inspection DHVwt7 ; E1X/F=D- Facility Address: 6421 Capital Ave City: Lodi Name of Designated UST Operator Conducting Inspection: Alex Jabbari `017 International Code Council Certification No.: 5243897-UC Expiration Date: 10/3/2018 Signature: hone _ r N/A=Not A plicable Item MONITORING PANEL/ALARM HISTORY Yes No N/A 1. Is the monitoring system powered on and in proper operating mode? 2. Is the monitoring system not currently showing any leak alarms? 3. Is the Alarm History Reportllog for the previous month available,and has it been reviewed by the Designated UST Operator? Attach a copy of the alarm history report/logreportllog to this ins ection orm. 4. 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:If the answer to Item a was "res,"or VA skip to Item 6.Sumps where an alarm has occurred in the past month must be inspected if a qualtfled service technician has not responded to and properly addressed,the cause o the alarm.Documentation verifying appropriate service should be attached to this re ort. No sumps alarm Yes No Yes No Sump Location: Sump Location: Sump Location: Sump Location: 6. Ares ill buckets containment structures free of water,debris,and hazardous substance? Yes No N/A I Yes No N/A Tank 1 ID—Regular Master Tank 3 ID—Premium Tank 2 ID—Regular Salve I Z I Lj I El I Tank 4 ID—Diesel Z El 1 11 7. Are under-dispenser containment areas free of water,debris,and hazardous substance? Yes I No I N/A Yes No N/A Dispenser— 1/2 Dispenser—9/10 Dispenser—3/4 0 Dispenser—11/12 Dispenser—5/6 ❑ Dispenser—13/14 11 Z Dispenser—7/8 Z Ej 1 0 Dispenser—15/16 8. Leak detection is properly located within under-dispenser containment. Yes No N/A I Yes No N/A Dispenser—1/2 Dispenser—9/10 Dispenser—3/4 Dispenser— 11/12 El1:1Dispenser—5/6 Dispenser— 13/14 ❑ El Z Dispenser—7/8 Dispenser— 15/16 PAPERWORK INSPECTION Yes No N/A Date Done 9. Monitoring System Certification was completed within the past 12 months? H El El 9/26/2016_ 10. Secondary containment tests completed within the required time frame? El1/20/2016 11. Spill bucket(containment structure)testing completed within the past 12 months? ❑ 9/26/2016 12. Tank tightness testing completed within the required time frame? ❑ 13. Line tightness testing completed within the required time frame? ❑ 15. Other required testing/maintenance was completed within required time frame? List test/maintenance items below. Describe Test/Maintenance:Air Quality9/26/2016 Describe Test/Maintenance: FACILITY EMPLOYEE TRAINING Yes I No I N/A 16. Have all facility employees received the required on-the-job training within the past earl Ej 17. Have all facili employees hired within the east 30 d!Xs received the required on-the job trainin L. ❑ Note: Explain any"No"answers in the"Comments" section on the following page.Those issues require corrective action from the UST owner/operator.