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Waterloo Foodmart 4315 E. Waterloo Rd. Stockton, CA 95215 <br />UNDERGROUND STORAGE TANK SYSTEM <br />DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT <br />Inspection Date: January 23. 2015 <br />Facility Name: Waterloo Shell <br />Focibly Address: 4315 E. Waterloo Rd C'ry Stockton <br />Name of Designated UST Operator Conducting Inspecuon: AIeX Jabbari <br />International Code Council Certification No.: <br />5243897 -UC Expiration Date: 10/3/2016 <br />Signature: <br />(925) 389-1262 <br />----.._.. ,....r.. I sr., r...".. ----1 ut <br />t ♦Unl'�U\C JiIHn\ h.�n. <br />r•� 1 rTf rv+vrrer!rn(fcratnr <br />The designated operator failed to document all the alarms from the attached alarm history on the 1-23-15 designated <br />operator monthly inspection reports and failed to check that they were responded to appropriately. The missing alarm <br />includes S1 on 1-20-15. <br />Page 9 of 9 Photo taken on 4-2-15 <br />6J <br />MONITORING PArmv.t.. r nu.nrar.. r..o. �.•-- <br />s the monitoring s stem owcred on and in proor o ratio mode? <br />- - <br />s the monitorin s stem not current) showinan Icak alarms? <br />the Alarm History Reportilog for the previous month available, and has it been reviewed by the <br />esi rated UST O --__? Anach a co n the alarm histo re ort/lo Io this rrts ection arm.as <br />each alarm for the revious month been res neoUST <br />F3.1s <br />SYSTEM INSPECTION <br />re tank -top containment sumps free of water, debris, and hazardous substance? Nou ryare a—er m lam ares.v..1 - rMp m ocrr. and r ro rhe o/rm Dooumemm�on ver r nau sr— sMuddhe wwchedrorho re rr1-18: <br />Vent annular s ace alarm Yes Num <br />Location: <br />Sum Location: <br />um Location: <br />Sump Location: <br />Li <br />6. <br />Ares ill buckets (containment structures) free of water, <br />debris, <br />and hazardous substance? <br />Yes No N/A I <br />Yes No N/A <br />Tank I ID - Regular 0 1 U I LJ I Tank 3 ID - <br />Tank 2 ID - Premium DQ I LJ I N I Tank 4 ID - <br />Li Li D9 <br />7. <br />Are under -dispenser containment areas free of water, debris, and hazardous substance? <br />Yes No N/A <br />Yes No N/A <br />Dis enser - 1/2 Dispenser - 9/10 <br />El– <br />Dispenser - 3/4 Dis enser-11/12 <br />Dispenser - 5t6 Dispenser- 13/14 <br />Li j7FFFF <br />Dispenser - 7%8 IN I Li I Li I Dispenser- 15/16 <br />8. <br />Leak detection is properly located within under -dispenser containment. <br />Yes I N I N/A I <br />Yes No I N/A <br />Dis nser–"2 Dispenser - 9110 <br />Dis nser-3/4 Dis enser- 11/12 <br />Dispenser - 5/6 D19 I LJ LJ I Dispenser - 13/14 <br />Dispenser - 7/8 1 DQ I Li I Ll I Dispenser - 15/16 <br />PAPERWORK INSPECTION Yes No N/A <br />Date Done <br />9. <br />Monitoring System Certification was completed within the past 12 months? ® <br />4/3/2014 <br />10. <br />Secondary contamment tests completed within the required time frame? <br />Brine <br />11. <br />Spill bucket (containment structure) testing completed within the past 12 months? LJ <br />4/3/2014 <br />12 <br />Tank ughmess testing completed within the required time frame?4. ff <br />13. <br />Linc tightness testing completed within the required time frame? <br />- <br />I5. <br />– <br />I'7 <br />Other required testrn • mamtenan_ ce was completed within required time frame? (Lis( test/marntenanc, items brlasv.l <br />Devcrtbe Test/Maintenance S 1 27 and S 130 _ _ 9122/2014 <br />I)csr-nbc Test/Maintenancc <br />-----__ I A( 11.11 Y VVIPLOYP4 'I-RA1NINt: _ VcsNo N� <br />Ila va all facility crrplr,yr.. n... v. d the ni.lurt. I.- the-p.h lrnnu r� . �iI... the Pa.t <br />Ilave all faoilitrn erl..lurid w whin th. r.i 4U d.n. i _ oJfth.` <br />----.._.. ,....r.. I sr., r...".. ----1 ut <br />t ♦Unl'�U\C JiIHn\ h.�n. <br />r•� 1 rTf rv+vrrer!rn(fcratnr <br />The designated operator failed to document all the alarms from the attached alarm history on the 1-23-15 designated <br />operator monthly inspection reports and failed to check that they were responded to appropriately. The missing alarm <br />includes S1 on 1-20-15. <br />Page 9 of 9 Photo taken on 4-2-15 <br />6J <br />