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C <br />Designated Underground Storage Tank (UST) Operator <br />Monthly Visual Inspection Checklist <br />Facility Name: Ryder Stockton <br />Date: 12/3/14 <br />Facility Address: 3633 Duck Creek Drive <br />City: Stockton <br />Zi Code: 95215 <br />Designated UST Operator Conducting the Inspection: Rolando Urbina <br />Monitoring system is )%%cred on and in proper operating mode. X <br />International Code Council Certification #: 8009631 -UC <br />Expiration Date: 10/8/16 <br />Signature: <br />Phone: 408-942-8686 <br />i <br />item <br />- - <br />MONITORING PANEL IA1.ARs1 IIISTORI 7 l N <br />--- <br />NA <br />I <br />Monitoring system is )%%cred on and in proper operating mode. X <br />_' <br />-Monitoring s\ stem is not currentl\ sho%%in r an) alarms or %%arnin rs. X <br />3 <br />Alarm histon reporulog for the pre\ ious month is as ailahle. and has been re\ ie%%cd h% the X <br />Iksi naled I. I Operator. 1. (Baal! a coln, 01 the alarm histon• rt• )url loss ha this tilrin it avildahl" <br />4 <br />Each alarm llor the re\ ious month has been res coded to apfinipriatcly. X <br />5 <br />_ <br />Sensors located in tank -top containment sumps ha\c not alarmed in the past month. X <br />5a <br />- list all tank -fop sumps is -here ah#rms occurred in the past <br />month <br />Nae: Smnp, to an alarm ion , a, arced br #ha pm# mark maut he uuprc1ed Muss u q&W#kd serr/nr #eehnrcwsr rr*v#&4+d #A #rut <br />prryrerh attire tied ilk' carne „t rhe alanrr . t wan k t%rrCNrna mudrq �rfit x tgy+sgrirrre sen rc a #u #hr. retrrrrr <br />if +arra r au v, mm r.r re, tared. re.,,rJ r: ur/r+ ar aeM 6. helao <br />..ar <br />tls'f s1 sT61 INSPECTION <br />6 <br />I•ank-tap containment sumps are kv of \nater. debris, and hat ardour substance. Sensors are hated properK. <br />\gar 1'uwl rn•a tam o! rnnr ,� n utak rr arreJ in swrr a where rm alarm has m t arrrd in thepall m„rah %ar a hick there Lino en <br />sen,! -e ret ord <br />V NN, <br />N <br />_ <br />Sunt 1 Locution. Diesel stain X <br />.1;wnp Locution. l'rsed flit X <br />Sump Location. Diesel Rcscrae X <br />sidnip Location- <br />.Sum Location: 'het% Oil X <br />.51/111 Location. <br />7 <br />Spill containment structures are free of water. debris. and haiardous substance. <br />1 N NA 1',N <br />FNAI <br />Tank I Content,; Diesel %lainX "tank 3 ('ontents: Ncss ail X <br />_ <br />Tank 2 c'onte'nts Diesel Rest.-meX Tank a ('untents- Used Oil <br />Under—dispenser containment areas are free ofwater. debris, and hazardous substance. Sensors are located ro <br />1—. <br />8 <br />Y N NA V N <br />NA <br />Dia 1enscr 1,2 X /)ts ,cover 4 X <br />Dia enser 3-4 X 11i.11enser <br />X <br />Dispenser I X Dis user <br />X <br />Dis nser 2 X (lis user <br />X <br />PAPERWORK INSPECTION Y N NA DATE DONE <br />r1312 <br />Monitorings\ stem certification has been completed within t 12 months. X 119/14 <br />Secondary containment tests have been compicttd within the rt-quired timeframe. X 1/10/12 <br />Spill containment structure (bucket) testes anuscompleted %%ithin the past year. X 1/9/14 <br />'rank ti htness testin was com leted within uired timeframe. X <br />line tightness testing was completed within required timeframe. X <br />14 <br />0thcrrcquirvd testingimaintcnance was com leted within required timeframe. (List test 'maintenance items below) <br />TestMaintenance <br />Test tlaintenance: <br />Test ,tlaintenance. <br />FACILITY EMPLOYEE: TRA INING 1' \ <br />N:► <br />15 <br />16 <br />All facilit\ em loyecs have reccked the rctluircd on-the-job training within the past %car. X <br />All facilit\ em lo\cc-s hired within the past 30 da\ s ha%c rcc eked the required on-the-job trainine f t <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 />Page I ot'2 <br />September 2004 <br />