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Y 9 <br /> Designated Underground Storage Tank(UST) Op�ra4 " <br /> Monthly Visual Inspection Checklist C!..:i �4z 15 <br /> Facility Name: 7-11 19976 Date: 3/15/2016 <br /> Facility Address: 1399 N.MAIN ST. <br /> City: MANTECA Zip Code. 95336 <br /> Designated US rator Conduc ' g the Inspection: Laura Gomez <br /> International o oun Cert' c tion#: 8344748 Expiration Date: 4/14/2017 <br /> Si Phone: (949)460-5200 <br /> Y=Yes,N=No,NA—Not Applicable <br /> Item I M ]TO jG�PANELLARM HISTORY Y N NA <br /> Monitoring System is red on d i propemode X <br /> 2 Monitoring system is not currently s wing any alarms or warnings. X <br /> 3 Alarm history report/log for the previous month is available,and has been reviewed by the Designated UST X <br /> operator. (Attach a copy of the alarm history rcporUlog 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 stamps where alarms occurred in the past month: <br /> L5:RUL Fill Sump;L6:Prem Fill Sump <br /> Nole: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 .use of the alarm.Auachl documentation verifying appropriate service to this report.lfsump inspection is 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 /> Note:D7sual impection orsumps is only.required hi sumps where an alarm has occurred in the past month_ror x•hich there Lino sendke record. <br /> Y N '..4 . Y N <br /> Stimp Location: NA Sump Location: <br /> Sump Location: VA Stomp LnCalion: NIA <br /> Sump Location; van Sump Location: KA <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 substance, Sensors are located properly. <br /> Y N NA Y N NA <br /> Dispenser-112 X <br /> Dispenser-3/4 X <br /> AMAXAZU <br /> PAPERWORK INSPECTION Y N NA DATE DONE <br /> 9 Monitoring system certification has been completed within past 12 months. X 10/7115 <br /> 10 Secondary containment tests have been completed within the required timeframe. X 12/18115 <br /> I I Spill containment structure(bucket)testing was completed within the past year. X Iot7n5 <br /> 12 Tank tightness testing was completed within required timeframe. X NIA <br /> 13 Line tightness testing was completed within required timeframe. I I X NIA <br /> 14 Other required testing/maintenance was completed within required timeframe,(List test/maintenance items below) <br /> Test/Maintenance: X N/A <br /> Test/Maintenance: X NIA <br /> Test/Maintenance: 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 All facility employees hired within the past 30 days have received the required on-the-job training. 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 l of 2 <br />