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Designated Underground Storage Tank (UST) Operator <br /> Monthly Visual Inspection Checklist <br /> Facility Name:West valley Auto Service,LLC Date:February 24,2016 <br /> Facility Address:2615 W.Grant Line Rd. <br /> City:Tracy,CA Zip Code:95304 <br /> Designated UST Operator Conducting the Inspection: Rick Branchini <br /> International Code Council Certification#:5241043-UC Ex iration Date: 07/17/2016 <br /> signature: R%el2grcl"Kva Phone:(925)699-1396 <br /> Y=Yes,N=No,NA=Not Applicabie <br /> Item MONITORING PANEL/ALARM HISTORY Y N NA <br /> r41 Monitoringsystem is powered on and in proper operating mode. X <br /> 2 Monitoringsystem is not currentlyshowingan alarms or warnings. X <br /> 3 Alarm history report/log for the previous month is available,and has been reviewed by the X <br /> Designated UST Operator. Attach a co o the alarm histo re orillo to this form i available. X <br /> Each alarm for the previous month has been responded to appropriately. X <br /> 5 Sensors located in tank-to containment sum s have not alarmed in the past month. <br /> 5a _ List all tank-top sumps where alarms occurred in the past month: See notes page 2 <br /> Note:Sumps where an alarm has occurred in the past month must be inspected unless a qualified service technician responded to,and <br /> properly addressed the cause of the alarm.Attach documentation verifying appropriate service to this report. <br /> MTank-top <br /> inspection is required,record results in item 6,below. <br /> UST SYSTEM INSPECTION <br /> inment sumps are free of water,debris,and hazardous substance. Sensors are located properly. <br /> s coon o sum s is on/ re uiere an alarm has occurred in the st month or which there is no srvia record.Y N <br /> : 87 N/A Sum Location: <br /> n: 91 N/A Sump Location: <br /> Sump Location: Diesel N/A Sump Location: <br /> 7 Spill containment structures are free of water,debris,and hazardous substance. Y <br /> Y N NA N NA <br /> Tank 1 —Contents:Premium U/L X Tank 3—Contents:Regular U/L X <br /> Tank 2—Contents: Diesel#2 X Tank—4—Contents: <br /> 8 Under-dispenser containment areas are free of water,debris,and hazardous substance. Sensors are located rN erl NA <br /> Y N NA <br /> Dispenser 1/2 X Dispenser 9/10 X <br /> Dispenser 3/4 X Dispenser 11/12 X <br /> Dispenser 5/6 X Dispenser 13/14 X <br /> Dispenser 7/8 X Dispenser 15/16 X <br /> PAPERWORK INSN <br /> Y N73/2 /2 <br /> 9 Monitoring system certification has been completed wimonths. X10 Secondar containment tests have been com leted withed timeframe. X1 l S ill containment structure(bucket)testin was com he ast ear. X12 Tank ti htness testin was feted within re uired t 13 Line ti htness testin was com leted within re uired tine Leak Detector X <br /> 14 Other required testing/maintenance was com feted within re uired timeframe. (List test/maintenance items below. <br /> Test/Maintenance:SB-989 u testin 12-17-1 S UST Com Bance,Inc. <br /> ollow <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> FACILITY EMPLOYEE TRAINING Y N NA <br /> 15 All facility employees have received the required on-the-job trainin within the past year. X <br /> 16 All facility em loyees hired within the past 30 da s have received the re uired on-the j b training- X <br /> Note: Any answer of"N"should be explained in the comment section on the following page,and will require <br /> follow-up action. " <br /> APR 15 2015 <br /> Page 1 of 2 November 2004 <br />