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n O cu UNDERGROUND STORAGE TANK SYSTEM DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT CL 9 Facility Name: West Valley Chevron Inspection Date: October 22, 2015 Facility Address: 2615 Grantline Rd- City. Tracy 0 Name of Designated UST Operator Conducting Inspection: Robert Barnhart NInternational C Council Certification Na: 5252540-UC Expiration Date: 2/1/2016 CD (� O Signature:/ Phone: t )604-9336 ext. '-r amaNIA-Not A Rlicablc CL item MONITOLNG PANEL/ALARM HISTORY Yes No N/A 0 �-7 1. Is the monitorin system powered on and in proper operating mode? ❑ `1 2, 1 is the monitorings stem not currently showing any leak alarms? ® ❑ ❑ 0 ;3. Is the Alarm History Report/log for the previous month available,and has it been reviewed by the ® F-3ED]7 Designated UST Operator? (, ttach a cool o the alarm hislon,re orr/!o to[his ins ection orm.) D 4. Has each alarm for the 2revious month been responded to appropriately? ❑ ❑ 1 ® C UST SYSTEM INSPECTION O ;5. Are tank-top containment sumps free of water,debris,and hazardous substance? Note:If the answer to Item 4 ryas"Yes.-skip (n to Item 6.Sumps+There an alarm has occurred in the past month must be inspected tf a qualified service technician has not responded to.and ro r/ addressed.the souse n the alarm,Documentaries,veri •in a ro mate service should he attached to this report. CD � Yes No Yes No _ '" Sum Location: � ❑ ❑ Sum Location: ❑ ❑ n U) Sum Location: ❑ ❑ Sum Location: ❑ I ❑ (p Are s ill buckets(containment structures)free of water,debris,and hazardous substance? r tp Yes No N/A Yes No N/A r Tank 1 ID-Premium ® ❑ ❑ Tank 4 ID- ❑ ❑ ❑ Tank 2 ID-Diesel ® ❑ 1 ❑ Tank 5 ID- ❑ ❑ ❑ Tank 3 ID-Regular I ® i ❑ I ❑ Tank 6 ID- ❑ I ❑ ❑ IV Are under-dispenser containment areas free of water,debris,and hazardous substance? Yes No N/A Yes No N/A is enser-1/2 ® ❑ ❑ Dis enser-9/10 ® ❑ ❑ Ul is enser-3/4 ® ❑ ❑ Dis enser- 11/12 ® ❑ ❑ is enser-S/6 ® ❑ ❑ Dis enser-13/14 ❑ ❑ ❑ N iSpenser-7/8 ® ❑ ❑ Dis enser-15/16 ❑ ❑ ❑ N ak detection is properly located within under-dispenser containment. '--r Yes I No I N/A I YNo N/A G) Dis enser-1/2 ® ❑ ❑ es Dispens e ❑ ❑ enser-3/4 Dispenser :3 enser-5/6 ® ❑ I ❑ I Dispenser-13/14 El ❑ ❑ f— Spenser-7/8 ® ❑ ❑ Dispenser- 15/16 ❑ ❑ ❑ PAPERWORK INSPECTION Yes No N/A Date Done (D ilitoring System Certification was completed within the past 12 months? ® ❑ ❑ 3/2512015 x Leak Detectors were tested/certified within the past 12 months? ® ❑ ❑ 3/25/2015 W bucket(containment structure)testing completed within the past 12 months? ® ❑ ❑ 3/25/2015 Q- til;htness testing completed within the required time frame? ❑ ❑ tidal containment tests completed within the required time frame? ® El El 3/2712012 anted Leak Detection completed within the required time frame? El ® n her required testing/maintenance was completed within required time frame? (List test/maintenance items below.) `C escribe TestlMaintenance: El ❑ ❑ n ibe Test/Maintenance: ❑ r--1F-1 >y O O p FACILITY EMPLOYEE TRAINING Yes No N/A 0 facilityemployees received the required on-the-job training within the past year? CD lfacili!L,em2loyees =3 hired within the past 30 days received the required on-the-job training.? ® ❑ ❑ W =3 1:"No"answers in the"Comments"section on the following page.Those issues require corrective action from 0 wllerlaperator. w www.unidoes.org + N �. O