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Ln O C"i Designated Underground Storage Tank(UST)Operator 00 u Monthly Visual Inspection Checklist N Factlny Name Date: t-.t-y !L, 72.,--,t �Facili •Address: Citv: Zi Co& O Desi ed UST for ConducAn the I tion: Ruben Galindo with Franzen-hill Corp (DIntecrtational Code ouncil Certification#:8028971-UC E iration Date: 7-( Y U St Phone:(559)688-2977 ^` Y=Yes,N-No,NA-Not A ticable (y O Item MON ORING PANEL/ALARM HISTORY Y N NA 0 1 Momto syst is veered on and in ro r o eratin mode. -0 t1 2 Monitorill system is not currently showing any alarms or warnings- 3 Alarm history report/log for the pm•ious month is available,and has been reviewed by the -� Desi ted"T"T9perator. Wfach a copy o the alarm history reporillog to thisform i available.) 4 Each alarm for the revious month has been responded to appropriately. - U 5 Sensors located in tank-top containment su s have not alarmed in the month. +j 5a - last all tankrop sumps where alarms occurred in the past month: _ _ nE� /r Note-Sumps where an alarm has occurred in the past month must be inspected unless a quatied service technician responded to.and W properly,addressed,the cause ojrhe alarm.Attach documentation venfping appropriate semce to this report. U) sump ins non is Leguired,record results in item 6,below. U) U) n UST SYSTEM INSPECTION v, 6 Tank-top containment sumps arc free of water,debris,and hazardous substance. Sensors are located properly. l) Note:Visual ins ection o sum s is only re cored in sums where an alarm has occurred in the post month for which there is no service record Y N Y N •L Sum Location: Sum Lacatinrt: I Sum Location: ---- Sum Location: 0_ 5 Sump Location: Sum Location: G 'r 7 S ill containment structures are free of water,debris,and hazardous substance. 0 Y N NA Y N NA E Tank 1-Contents 1 Tank 3-Contents: Tank 2-Contents: _it I Tank 4-Contents: 8 TJnder-dispenser containment areas are free of water,debris,and hazardous substance. Sensors are located properly. Y N NA Y N NA L Dispenser 1✓2 Dip eraser 9110 L co Dis enser 3/4 _ Dispenser 11/12 O 1 Dispenser 5/6 __ Dispenser 13/14 V O }i !_ Di penser 718 _ — Dispenser 15/16 QJ __ PAPERWORK INSPECTION Y N NA DATE DONE 9 Monitoring system certification has been completed witltin past 12 months. X - IZ L_ 10 Secondary containment tests have been completed within the required timeframe. X 5 -Z I-v) (� 11Spill containment structure(bucket)testing was completed within the past year. X $ 12 Tank tiphtnevz testin was completed within required timeframe. 13 Line tiphtness testing was completed within required timeframe. L.- 14 l4 Otlter re aired testing/maintenance was completed within required timeframe. (List test/maintenance items below.) O YnsvUaintenance: Testy, aintenance: TestNfainte_n_ane_e. 40 FACILITY EMPLOYEE TRAINING Y N NA O L-- 15 All facility employees have received the required on-the-job training within the past year. X U 16 All facilityemployees hired within the st 30 davs have received the required on-the-job trainui F+_X ote: Any answer of"N"should be explained in the comment section on the following page,and will require follow-up action.