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May,Q8 12 07:47p Lower Sacramento Chevron 2099540582 p.2 <br /> UNDERGROUND STORAGE TANK SYSTEM <br /> DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT <br /> Facility Name: Lower Sac Chevron inspection Date: January 20, 2012 <br /> Facility Address: 8660 Lower Sac City: Stockton <br /> Name of Designated UST Operator Conducting Inspection: Alex Jabbari <br /> International Code Council Certification No.: 5243897-UC Expiration Date: 10/2/2012 <br /> Signature: —- Phone- (925) 389-1262 <br /> .01 -Not Awlicable <br /> Item MONITORING PANEL/ALARM HISTORY Yes JNle— N/A <br /> 1. Is the monitoring system Vwered on and in proper operating mode? Wg= <br /> 2. Is the monitoring system not currently showing any leak alarms? <br /> 3. Is the Alarm History Report/log for the previous month available,and has it been reviewed by the <br /> Desi gHatedUST!?pstator? (Attach a caEtlox <br /> ,py of the alarm history Ee to this ens clionfo <br /> Has each alarm for the previous month been responded to ropriately? <br /> UST SYSTEM INSPECTION <br /> S. Are tank-top containment sumps free of water,debris, and hazardous substance? wore:if the answer to Item 4 was -Yes."or <br /> "N.4:'skip to Item 6.Sumps where an alarm has occurred in the post month must be mspecred if qualified service lechniclan has not responded <br /> I&,andECo <br /> .ZLt addressed,the vause gLrhL alarm..Documentation vert fvingapprWrate service should be attached to As re d. <br /> No sumps alarm Yes I No No sumps alarm Yes No <br /> Sum 2 Location: Sum E Location: 0 El <br /> Sump Location: Sump Location: <br /> 6. Are spill buckets(containment structures)free of water,debris,and hazardous substance? <br /> Yes No N I Yes No N/A_ <br /> Tank I ID-Regular Tank 3 ID-Premium N Li I Lj <br /> Tank 2 ID-Plus Tank 41D- <br /> 7. Are under-dispenser containment areas free of water,debris,and hazardous substance? <br /> Yes I No I N/A Yes No N/A <br /> Dispenser-112 0L01 0 Dispen r-9!10 <br /> Dinenser-314 Dispenser-11112 <br /> Dispenser-6/6 Dimenser 13/14 Q I <br /> Dispenser-7/8 _Dispenser-15116 <br /> S. Leak detection is proMly located within under-dispenser containment <br /> Yes Na I NIA I Yes No N/A <br /> DisRenser-112 Dispenser-9!10 <br /> Dispenser-3/4 Dispenser-11/12 <br /> Dispenser-516 Dispenser_13/14 <br /> Dispenser-7/8 1 Dispenser_ 15/16 0 1 010 <br /> PAPERWORK INSPECTION Yes No NIA Date Done— <br /> 9. Monitoring System Certification was completed within the past 12 months? 0 O 917/2011 <br /> 10. Secondary containment tests completed within the required time frame? 0 JO - 12J23/2008 <br /> It. Spill bucket(containment structure)testing completed within the past 12 months?—-0- E] 0 9/7/2011 <br /> 12. Tank tightness testing completed within the required time frame? Li Li N <br /> 13. Line tightness testing completed within the required time frame? <br /> 15. Other re aired testing/maintenance was com2leted within required time frame? (List tesr1mainlenance items below) <br /> Describe TestiMaintenance: 91712011 <br /> Describe TestMaintenance: I D 10 1 El <br /> FACILITY EMPLOYEE TRAINING Yes i No I N/A_ <br /> l6. Havc a,11 facility em219jees received the required on-the�ob training within the gMt yew? 01019- <br /> 17. 1 Have all facil!!X employees hired within the M 30 d=received the reLuired 22:g!!:j0b training.? <br /> Note: Explain any-No"answers in the"Comments"section on the following page.Those issues require corrective action from <br /> the UST owner/operator. <br />