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Designated Underground Storage Tank (UST) Operator <br /> Monthly Visual Inspection Checklist <br /> Facility Name: 7-1119976 Date: 2/16/2016 <br /> Facility Address: 1399 N.MAIN ST. <br /> City: MANTECA Zip Code: 95336 <br /> Designated UST e for Conducti the Inspection: Laura Gomez <br /> International de C nc Cent a on#: 8344748 Expiration Date: 4/1412017 <br /> Si Phone: (949)460-5200 <br /> Y=Yes,N=No,PFA=Not Applicable <br /> It IT RING PANEL/ALARM HISTORY Y N NA <br /> 1 Monitoring System is powered on n proper operating mode X <br /> 2 Monitoring system is not currently showing any alarms or warnings. X <br /> 3 Alarm history reportrlog for the previous month is available,and has been reviewed by the Designated UST X <br /> Operator. (Attach a copy of the alarm history report/iog to this form if available.) <br /> 4 Each alarm for the previous month has been responded to appropriately. X <br /> 5 Sensors located in tank-top containment sumps have not alarmed in the past month. X <br /> 5a - List all tank-top sumps where alarms occurred in the past month: <br /> L5:RUL Fill Sump <br /> Note:Sumps where an alarm has occurred in the past month must be inspected unless a qualified service technician responded to,and properly <br /> addressed the eause of the almm.Attach documentation venfj4ng appropriate service to this report.If sump inspection Ls required,record results <br /> in item 6,below. <br /> UST SYSTEM INSPECTION <br /> 6 Tank-top containment sumps are free of water,debris,and hazardous substance. Sensors are located properly. <br /> Nute.-r1sual inspection of sumps is only required in summ where an alarm hos occerred in the past mvwh for which There is no service record. <br /> Y N _= o Y N <br /> Sump Location: y'^ "'~ Sump Location: <br /> Sump Location: V'^ F Sump Location: WA ' <br /> Stomp Location: „ .. Sump Location: <br /> 7 Spill containment structures are free of water,debris,and hazardous substance. <br /> Y N NA Y N NA <br /> Tank-87 X <br /> Tank-91 X <br /> 8 Under-dispenser containment areas are free of water,debris,and hazardous sibst4m. ILKW614 <br /> Y N NA Y N NA <br /> Dispenser-112 X 0 C T 142016 <br /> Dispenser-3/4 X <br /> ENVIRONMENTAL Flt/J,LTF <br /> PAPERWORK INSPECTION ATE DONE <br /> 9 Monitoring system certification has been completed within past 12 months. X HMO <br /> 10 Secondary containment tests have been completed within the required timeframe. X 12/19/15 <br /> 11 Spill containment structure(bucket)testing was completed within the past year, X ton/1s <br /> 12 Tank tightness testing was completed within required timeframe. X NA <br /> 13 Line tightness testing was completed within required timeframe. X N/A <br /> 14 Other required testing/maintenance was completed within required timeframe.(List test/maintenance items below) <br /> Test/Maintenance: X NIA <br /> Test/Maintenance. X NIA <br /> TiullMaintenance: X N/A <br /> FACILITY EMPLOYEE TRAINING Y N NA <br /> 15 All facility employees have received the required on-the-job training within the past year. X <br /> 16 1 All facility employees hired within the past 30 days have received the required on-the-job training. I I X <br /> Note: Any answer of"N"should be explained in the comment section on the following page,and will require follow-up <br /> action. <br /> Page 1 of 2 <br />