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Designated Underground Storage Tank (UST) Operator <br /> Monthly Visual Inspection Checklist <br /> Facility Name: 7-1119976 Date: 4118/2016 <br /> Facility Address: 1399 N.MAIN ST. <br /> City:MANTECA A Zip Code: 95336 <br /> Designated UST at qonductigilhe Inspection: Laura Gomez <br /> International C de c' i ti #: 8344748 Expiration Date: 4/14/2017 <br /> ature. Phone: (949)460-5200 <br /> V—VM N=No,NA-Nat Appricable <br /> Item ONIT G PANEL 1 ALARM HISTORY Y N NA <br /> Monitoring System is pow on an in pro r operating mode X <br /> 2 Monitoring system is not currently sh w' 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 report/log 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 /> LS:RUL Fill Sump <br /> Note:Sumps where an alarm has occurred in thepast month must be inspected unless a qualtlled service technician responded to,and properly <br /> addressed,the cause of the alarm.Attach documentation verifying appropriate service to this report.If sump inspection is required.record results <br /> in item 6.below. <br /> UST SYSTEM INSPECTION <br /> 0 Tank-top containment sumps are free of water,debris,and hazardous substance. Sensors are located properly. <br /> Note. Visual inspection pj'sumps is only required in sumps where an alarm hay occurred in the past month for which there is noswwce retard. <br /> Y N Y N <br /> Sump Location: "'^ Sump Location: VA ,f <br /> Sump Location: "'" x`' y Sump Location: NIA <br /> -_ M <br /> Sump Location: "t^ r. Sump Location: <br /> 7 Spill containment structures are free of water,debits,and hazardous substance, <br /> Y N NA Y I N INA <br /> Tank-87 X <br /> Tank-91 X <br /> 8 Under-dispenser containment area,,,are ti-ee of water,debris,and hazardous substance, e c o e <br /> Y N NA Y <br /> Dispenser-112 X <br /> Dispenser-3/4 X <br /> ENVIRONMENAL I-lE <br /> PAPERWORK INSPECTION Y N N <br /> 9 Monitoring system certification has been completed within past 12 months. X 10/7/15 <br /> 10 Secondary containment tests have been completed within the required timeframe. X 1211815 <br /> 11 Spill containment structure(bucket)testing was completed within the past year. X 10/715 <br /> 12 Tank tightness tcsting was completed within required timeframe. X NIA <br /> 13 Line tightness testing was completed within required timeframe. X NIA <br /> 14 Other required testing/maintenance was completed within required timeframe.(List test/maintenance items below) <br /> TeyWaintenance: X NIA <br /> TestlMaintenance: _ X N/A <br /> Test/Maintenance: X NIA <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 explatned in the comment section on the following page,and will require follow-up <br /> action. <br /> Page l of 2 <br />