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Waterloo Foodmart 4315 E. Waterloo Rd. Stockton, CA 95215 <br />UNDERGRO TWSTORAGE'1'ANK SYSTEM <br />DESIGNATED UST OPERA'T'OR MONTHLY INSPECTION REPORT <br />Facility Nun"' Waterloo ShellIn'pcction <br />Da March 27, 2015 <br />ha tltt> Atidtsss: 4315 E. Waterloo Rd <br />Crty Stockton <br />Name of Designated UST operator Conducting Inspection: Alex Jabbari <br />International Code Council Certification No.: 5243897 -UC 1'.xpirauon Date 10/312016 <br />Signature: C'4' 'r _ Phone (925) 389-1262 <br />Item I MONITORING PANEL/ ALARM HISTORY <br />Vea No N/A <br />1. <br />Is the monitoring.,".em powered on and in proper cqwratmgmodel <br />Is the monitoring stem not currently showing any leak alarms? <br />3_ <br />1s the Alarm Histcuy Repan/ for the previous month available, and has it been reviewed by t},e <br />Desi ated UST rator? Atrach a copy o the alarm hislo rep—illog to this ins ect— ornr.) <br />3 <br />Has each alarm Cor the ,revious month been res nded W a ronatel y't <br />U ST SYSTEM INSPECTION <br />S. <br />jion: <br />Are tan,: -top containment sumps fret of water, debris, and hazardous substance? .v— lrtr ,naw, m nem J .a.. -tar. 'o• <br />"NA- r6p mlum Q Sumps where an alarm hat acvrruf rn rhe parr month mast br rnspecrul r/a y,1a(JieJ rernce rechmrrun hat rip • wed <br />rind 7 addessot, rhr cause rhe alma, /beumanranan .rn rsore ae•vlce should hr urruehc.! m rhra rr <br />1 fill sum atarrn Ves No Yea No - <br />ion: Sum l.cx:atinn: <br />raKAre <br />Sum Location: Li Lj <br />kets (containment swctures) foe of waterdebris, <br />and hazardous substance'' <br />Yea No N/A <br />Ves No N/A <br />Re lar Tank 3 ID - <br />Premium 'Cank 4 ID - <br />7. Arc under -d ser containment areas free of water, debris. and hazardous substance, <br />Yea No N/A <br />Yea I No I N/A <br />D- scr - 112 DQ I Li Li D,: cnscr- W 10 <br />'I <br />Di - -3l4 Drs nscr- I I/12 <br />LJ I IN <br />I <br />Di riser - 5/6 D,. -nscr - 13/14 <br />Di crus - 7/8 --- D, enser - 15116 <br />UM <br />is y t located within underd,. ser containment <br />8. Leak ck-tacuon <br />Yea No N/A <br />yp No N/A <br />D- riser- I/2 DI, enter-`1/Ill <br />j <br />- <br />ser -3/4 Di •nser- 11/12 <br />Dr user - 5/6 Drs cnsr.r - 13/ 14_ <br />Dr_ nscr -7, <br />PAPERWORK INSPECTION 1'u No N!A <br />Date Doric <br />System Ccruficatton was cum IctcJ wilh,n the pair 12 months? <br />4!3/2014 <br />' <br />). MoniWring <br />tests completed within the requited tune Game? <br />Brine <br />1 <br />t o. Secondary containment <br />11. Spill bucket (containment suucturc) tcsung crmtplcicd within the past 12 months'? <br />12. Tank tightness testing completed within the required time Cisme? <br />4/3/2014 <br />-- <br />r <br />13. Lute tightness testing completed within the requinxl time tramc? <br />... u,m�eled within rc utrtxl I,mc ,tame'? /.rst trsrimwntemruce rtrnrs hrinw <br />15. Other rc uired testm maintenance w— <br />Deacribc Tcsl/Maintcrui-1. I' 27 and S 1 3tr 9/22/2014 <br />Describe Tcnt/Maintcnance <br />- - - FACILITY EMPLOYEE TRAINING Yea No N/A <br />I6_ 11ave all facil,t • ru to ccs rcceived the ec imdu.rinvs rtu:rvixt the re r icd on-tl,o- bth.r trernin ' <br />the following page- r now rawaa reyauv 1.111-11.1 a..mm tion, <br />The designated operator failed to document all the alarms from the attached alarm history on the 3-27-15 designated <br />operator monthly inspection reports and failed to check that they were responded to appropriately. The missing alarm <br />includes L12 on 2-11-15. <br />Page 7 of 9 Photo taken on 4-2-15 <br />