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v c� m rn O IF W•n I t~p UN u UNp = =�--- —MONT ST�RAG iiitYName - _ -- N�Y VISUAL INSPECTIONE TANK ieST OPE'RATOniiiia A, "14 Address Quik 5top Market 41.32 ='- ,CHEC State, Zip 3555 W. Hammer Lane i9nated O on, CA 9521 nate October, 12, 2416 Operator Carpenter, Curtis 'Certification !r 8167865 -UC Item Expiration March 16, 201 Phone (91161825-72- Monitoring 916) 825-7857 I 1 Monitorm mUNITORtNG PANE 2 ----.-_ _ 9 system is powered on � ALARM HISTOR Mondorin and in �p ng --- -- - 9 system is NOT currengy show op, mode Y Y _ 1 3 Alarm history 2port I log for the -g y alarms or warnings. _ _ - 3a - - - _ - - Is a -Precious month is available and has_ SPY of the ala - _ ■ ❑ i rm history report / log to.this rarm2- been reviewed by the -Designated UST O Each--- alarm for the previous moot - - ■ ❑ h has been responded to a - Perator ■ ❑ nsors located m tank top containment sum PPropnately -- - _ List al! tank -to _ps have NOT alarmed in the past month ■ ❑ ❑ p sumps where alarms occurred L9 ala rred in the - -- - -- _ ed on 9-22 16. - - ._ -past month:, - _ -. - - ❑ ■ ❑ i R -- _ l -. Sumps where an alarm has occu _ - -- rred m the past month must be inspected unless a qualrired service technician esponded to an addressed, the cause o/the alarm. Attach documentation verifyinga - i Jrsum ins echon is required, record resulls in item 6, below PPropnate service to this report. UST SYSTEM INSPECTION 6 Tank -to p _ Tank -top containment sum s are free of water, debris, and hazardous substanceSensors are located properly Note.' Visual inspection or sumps is only required m sumps where an alarm has occurred in the past month for which there ,s no service record. Sump Location Y N Sump Location. ❑ ❑ _. ^Sump Location: 11 El 7 Spill Containment Structures are free of water, debris, and hazard" substance ; { Tank 1 -Gasoline 87 Y N NAI Y N NA t Tank 2 ■ Tank 3 - Gasoline 91 ■ ❑ ❑"j' -Gasoline 89 El ❑■ ❑ ❑ - - - n er-dispenser containment areas are free of water, debris and hazardous substance. Sensors are located property. Y N NA Dispenser J / 2 ■ ❑ ❑ Dispenser 3 / 4 ■ ❑ j ❑ Dispenser 5 / 6 ■ ❑ ❑ z Dispenser 7 / 8 : ■ ❑ ❑ . _ _---- --- _,_..._ _ ...... PAPERWORK INSPECTION Date Y N NA!!, 9 Monitoring system certification has been completed within the past 12 months 04/18116 ■ 10 Secondary containment tests have been completed within the required timeframe 04123115 ■ U❑ ; 11 Spillcontainmentstructure (bucket) testing was completed within the past year 04118116 ■ ❑ ❑ 12 Tank tightness testing was completed within the required timeframe.,-� ❑ _- 13 Line tightness testing was completed within the required timeframe. 14 Other required testing / maintenance was completed within the required timeframe. (List items below) Test/Maintenance Air Quality Test - - Test/Maintenance FACILITY EMPLOYEE TRAINING lity employees have received the required on-the-job training within the past year, _ -the-job training ity employees hired within the past 30 days have received the required on 0 Page 1 03110116 , ■ 0^ ❑ _._❑ ❑ ■ Y N HA O O 0 N N 0 rn K O I Q N O �z t7 (n mm o n (n� (n CID CN CD0 O cn CD 1 N N C) --ACD N m W O 0 O 7 ro 0 O Q 0 0 N w w 0