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Designated Underground Storage Tank (UST) Operator <br />Monthly Visual Inspection Checklist <br />Facility Name: 7-11 19976 <br />Date: 09/07/2016 <br />Facility Address: 1394 N. MAIN ST. <br />I N INA <br />City: MANTECA <br />Zip Code: 95336 <br />Designated UST Operator Conducting the Inspection: Kaylynn Rammell <br />International Code ouncil Certificat' #: 845A633 <br />Expiration Date: 6/15/2018 <br />Si store: <br />Phone: (949) 460-5200 <br />►r4 <br />Y m Yes, N — No, NA — Not Appneable <br />Item <br />MONITORING PANEL I ALARM HIS'T'ORY <br />Y <br />I N INA <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 aiarm has occurred in the past moral+ mast he inspected unless a qualified se <br />addressed, the cause of the alarm..4ttach documentation verifying appropriate service to this report, ion <br />in item 6. below. 11 <br />o j <br />tr l <br />j f,.:-� <br />UST SYSTEM INSPECTION <br />6 <br />Tank -top containment sumps are free of water, debris, and hazardous substance. Sensors are located r per <br />Nore: Visual inspection ofsumps is only required in sumps where an ntarm has occurred in the part month for wln'ch there is no service record. <br />Y <br />NENVIRONM <br />Sump Location: "'^ <br />Sump Location: "'" <br />TL A <br />a.LT <br />Sump Location: "" <br />_ <br />Sump Location: "i^ <br />Sump Location: "JA <br />Sump Location: WA <br />7 <br />Spill containment structures are free of water, debris, and hazardous substance. <br />Y N NA <br />Y N INA <br />Tank -87 X <br />Tank -91 X <br />8 <br />Under -dispenser containment areas are free of water, debris, and hazardous substance. Sensors are located properly. <br />Y I N I NA <br />Y N NA <br />Dispenser -1 /2 X <br />Dispenser -3/4 X <br />PAPERWORK INSPECTION Y N NA <br />DATE <br />9 <br />Monitoring system certification has been completed within past 12 months. X <br />1017115 <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 />1017115 <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 <br />NIA <br />14 <br />Other required testing/maintenance was completed within required timeframe. (List test/maintenance items below) <br />Test/Maintenance. TX F <br />N/A <br />Test/Maintenance: X <br />NIA <br />Test/Maintenance: X <br />NIA <br />FACILITY EMPLOYEE TRAINING <br />Y I 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 />1 All facility employees hired within the past 30 days have received the required on-the-job training. <br />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 />