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%. S <br />Designated Underground Storage Tank (UST) Operator p . <br />Nlonthly Visual Infection Checklist��%I�jn <br />Facilit< Name: waterloo Shell <br />Facility- Address: 4315 Waterloo <br />Citv.- Stockton Zip Code: <br />Designated UST O Erator Conducting the Inspection: Lori Freshour <br />Ititemational Code Coupcil Certification #: 5220353-1;C Expiration Date: 9/17/07 <br />Sienature' Phone (916)826-1i76 P te— - <br />Item MONITORING PANEL. AIARM HISTORY <br />1 \fonitorin� a,tant i., tottered on and in proper of eratin g node Y N NA <br />%Ionitoring st'tent i., not vrrenth' .hots in am tl tntn or a innings y I <br />\larm hrt0.tn report h-) for the pr V ruts month is available. and has been reviewed y J <br />h� the D�stgnat�d [ 51 Operantr. 1 <br />r. itr.rch .r : npt• ra/ the u;arm h;srnn' rettr,r-t ,,, to this t;rrnr r(orarlahl.ri �/ <br />-t Fach alarm t,tr the re%ious month has been lrr, ondcd to a ro riatel%. 7 = <br />? r l t <br />t SensOrn lo. ted in the larlt -lJp ' nlalnntdnl untps hac not alarmed in t_hc past month <br />t <br />L, tt ,u( r,rne-rrtp tnmfts t, here ,rarrurs ,>cuu-,•<•J in the pn.t'r month: _ <br />.vtc: ;'r,ngzc ;rhtrc n a'arnr hot o r rrcJ.n th., •tttnronth mrtr hem,1 � � <br />i r"a meted unl cs a /rmirfird ,an t ,`±tnrc:.itr •,•. r v;ded tn. ,and <br />1 , r >f crit a/.Inc• rl th..au rc r,i the rl arra.. I rr r h Jo, wncnr atr n , < n/t'rm � r/,1trc prnre s, ?"C" sr tltr t 11pnrr. I n%j{ <br />,l irlrr!/7 ;rt•'c'Cr'r�n ,, tr r"I I'd '77r r �l rrt nrl M <br />1 ! n cy'ritl'. <br />I — _ <br />UST SYSTEM INSPECTION — <br />6 I Tank-topcontainmef t sumps <br />arefree ofwater,�d hazardous substance. Sensors are properly <br />cdDection ps is edrsumps Ne an aarm aoudeast cnth orh there is <br />record <br />Y W - ! <br />Sump Location.' Y N ; <br />I Sump Location: <br />Sum Location. Sump Location: <br />Sump Location: i Sum Location: <br />7 Spill containment structures are free of water, debris, and hazardous substance. <br />N NA <br />Tank 1- Contents Iii Y Tank 3 - Contents Y N NA <br />Tank 2 -Contents y� r2 = 1 Tank 4 -Contents <br />8 UDC areas are free of water, debris, and hazardous substance. Sensors are properly located. <br />Y N NA WNNA <br />Dispenser 1 / 2 Dis enser9/10 <br />Dis enser3/4Dispenser 11 / 12 <br />Dis enser5/6penser 12/ 13 <br />Dis enser 7 / 8penser 14 / 15 <br />PAPERWORK INSPECTION <br />9 I Monitoring system certification has been completed within the past 12 months <br />10 I Secondary Containment tests have been completed within the required timeframe <br />11 Spill containment structure (bucket) testing was completed within the past year. <br />12 1 Tank tightness testin2 was completed within required timeframe. <br />13 Line ti htness testin was completed with required timeframe. <br />14 Other required testing maintenance was completed within required timeframe (List <br />Test/Maintenance. <br />Test/Maintenance.' - - - <br />_-- L Test/Maintenance: — — <br />la <br />test/ maintenance items <br />LL 17 I v i <br />N I NA <br />DATE DONE <br />S'-g-vcp <br />o Le <br />I----,-- _ FACILITY EMPLOYEE TRAINING Y ' N � NAJ <br />15 ,II facifty em Ieyees have r eceiyed the required cr, the jeb training within the past year. _ _ <br />16 All facility emplcyees hired within the past 30 day have received the required on the job training — --� ---- <br />Note: Any answer of '`N" should be explained in the comment section on the following page, and will require follow-up action. - - <br />Comments <br />Fallow -up action required: <br />Dealer i Manager Signature <br />Date: <br />