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Designated Underground Storage Tank (UST) Operator <br />Monthly Visual Inspection Checklist <br />Facility Name: 7-11 19976 <br />Date: 05/17/2016 <br />Facility Address: 1399 N. MALN ST. <br />City: MANTE <br />Zip Code: 95336 <br />Designated T Op e for knductin&c Inspection: Laura Gomez <br />Monitoring system is not currently sho in 1&y alarms or warnings. <br />ific t <br />Int 1 Code oune C#: 8344748 <br />Expiration Datc: 4/14/2017 <br />ignature <br />Phone: (949) 460-5200 <br />I ( Y XN / I \ Y = Yes, N = No, NA = Not Applicable <br />tem <br />ON1TO PANEL. / ALARM HISTORY <br />Y N NA <br />Monitoring System is po ed on and ' pro r operating mode <br />X <br />2 <br />Monitoring system is not currently sho in 1&y alarms or warnings. <br />X <br />3 <br />Alarm history reportilog for the previo 14onth is available, and has been reviewed by the Designated UST <br />Operator. (Attach a copy of the alarm history report/log to this form if available.) <br />X <br />4 <br />Each alarm for the previous month has been responded to appropriately. <br />x <br />5 <br />Sensors located in tank -top containment sumps have not alarmed in the past month. <br />X <br />5a <br />- list all tank -top sumps where alarms occurred in the past month: <br />L2: RUL STP Sump; L4: Premium STP Sump <br />Note: Sumps where an alarm has occurred in the past month must he inspected unless a qualified service technician responded <br />addressedI the cause of the alarm. Attach documentation verifying appropriate service to this report. lj'sump inspection is requireA <br />in item 6, helow. <br />to, and properly <br />record results <br />UST SYSTEM INSPECTION <br />6 <br />Tank -top containment sumps are free of water, debris, and hazardous substance. Sensors are located properly. <br />Note: Ycsual inspection o/sumps is only required in camps where an alarm has accur rdin the past month for which there is no service record. <br />Y N ,;.4: <br />Sump Location: *l:. Sump Location: <br />Y N <br />Sump Location: N!A " Sump Location: "A <br />Sump Location. N'" d Sump Location: <br />7 <br />Spill containment structures are free of water, debris, and hazardous substance. <br />Y N NA <br />Y N NA <br />Tank -87 X <br />Tank -91 X <br />8 <br />Under -dispenser containment areas are free of water, debris, and hazardous substance. Sensors r <br />Y N NA <br />Dispenser -112 X <br />Dispenser -3/4 X 0:1 <br />PAPERWORK INSPECTION Y N <br />T <br />9 <br />Monitoring system certification has been completed within past 12 months. X <br />t i 5 <br />10 <br />Secondary containment tests have been completed within the required timeframe. X <br />12/18/15 <br />11 <br />Spill containment structure (bucket) testing was completed within the past year. X <br />iontm <br />12 <br />Tanis tightness testing was completed within required timeframe. X <br />N/A <br />13 <br />Line tightness testing was completed within required timeframe. x <br />N/A <br />14 <br />Other required testing/maintenance was completed within required timeframc, (List test/maintenance items below) <br />Test/Maintenance: X <br />NIA <br />Test/Maintenance: X <br />N/A <br />Test/Maintenance: X <br />N/A <br />FACILITY EMPLOYEE TRAINING <br />Y N NA <br />15 <br />1 All facility employees have received the required on-the-job training within the past year. <br />X <br />16 1 All facility employees hired within the past 30 days have received the required on-the-job training. iX <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 />:C <br />ALTRI <br />