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Designated Underground Storage Tank (UST) Operator <br />Monthly Visual Inspection Checklist <br />Facility Name: 7-1119976 <br />Date: 08/09/2016 <br />Facility Address: 1399 N. MAIN ST. <br />NA <br />City: MANTECA <br />Zip Code: 95336 <br />Designated UST Operator Conducting the Inspection: Kaylynn Rammell <br />International Cod Council Certi ion #: 1456633 <br />Expiration Date: 6/15/2018 <br />Signature: <br />Phone: (949)460-5200 <br />Y = Yes, N = No, NA = Not Applicable <br />Item <br />MONITORING PANEL / ALARM HISTORY <br />Y N <br />NA <br />1 <br />Monitoring System is powered on and in proper operating mode <br />X <br />2 <br />Monitoring system is not currently showing any alarms or warnings. <br />X <br />3 <br />Alarm history report/log for the previous month 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 />Note: Sumps where an alarm has occurred in the past month must be inspected unless a qualified service technician responded <br />addressed, the cause of the alarm. Attach documentation verifying appropriate service to this report. if sump inspection is required, <br />in item 6, below. <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: Visual inspection pfsumps is only required in sumps where an alarm has occurred in the past month for which there is no service record. <br />Y N <br />Y N <br />Sump Location: NIA <br />Sump Location: Nt^ <br />Sump Location: NIA <br />Sump Location: WA <br />Sump Location: N/A <br />Sump Location: Nl^ <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 hazar u ce. Sensors are located properly. <br />Y N NA <br />Y N NA <br />Dispenser -112 X <br />1 <br />Dispenser -3/4 X P'L- <br />Vi0 <br />�P <br />PAPERWORK INSPECTION Y N NA <br />DATE <br />9 <br />Monitoring system certification has been completed within past 12 months. X <br />10/7/15 <br />10 <br />Secondary containment tests have been completed within the required timeframe. X <br />12/19/15 <br />11 <br />Spill containment structure (bucket) testing was completed within the past year. X <br />10/7/15 <br />12 <br />Tank tightness testing was completed within required timeframe. X <br />N/A <br />13 <br />Line tightness testing was completed within required timeframe. X I <br />N/A <br />14 <br />Other required testing/maintenance was completed within required timeframe. (List test/maintenance items below) <br />Test/Maintenance: X <br />N/A <br />Test/Maintenance: X <br />N/A <br />Test/Maintenance: X <br />NIA <br />FACILITY EMPLOYEE TRAINING <br />Y N NA <br />15 <br />All facility employees have received the required on-the-job training within the past year. <br />X <br />16 <br />All facility employees hired within the past 30 days have received the required on-the-job training. <br />X <br />Note: Any answer of "N" should be explained in the comment section on the following page, and will require tollow-up <br />action. <br />Page 1 of 2 <br />