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I UNDERGROUND STO GE TANK SYSTEM DESIGNATED UST OPERATOR MO THLY INSPECTION REPORT Facility Name: Lodi Food & Liquor Inspection Da;95240 12 Facility Address: 1225 Lockford Street City: Lodi, CName ofDesignated UST Operator Conducting Inspection: C /uInternational Code Council Certification No.: L� e: (O l � 1✓�Signature: �� 371-2380 ext. N/A=Not A licable Item MONITORING PANE RM HISTORY Yes o N/A 1. Is the monitoring s stem powered on and in proper o eratin ode? El 2. Is the monitorings stem not currents showin an leak alar ? o 3. Is the Alarm History Report/log for the previous month avail a le,and has it been reviewed by the Desi nated UST O erator? Attach a ril ll the alarm histo repart1log report/logto this ins ection orm. t 4. Has each alarm for the revious month been res onded to app4o riatel ? UST SYSTEM INSP CTION 5. Are tank-top containment sumps free of water,debris,and ha rdous substance? Note:ff the ans,ver to Item 4,vas "Yes,"skip to Item 6. Sumps where an alarm has occurred in the past[month must be nspected if a qualified service technician has not responded to, and properlyaddressed,the cause of the alarm.Docunrentatton vers in a ro tale service should be attached to this report. Ye: Yea No Sum Location: Su Location: ski Su Location: Sum Location: 6, Are s ill buckets(containment structures free of water,debri ,and hazardous substance? yes No N/A Yes No N/A Tank 1 ID—87 T k 4 ID— Tank21D-91 Ta ik5ID— _ , _._._. T _ 6ID— Tank 3 1D-DSL 7. Are under-dispimser containment areas free of water,debris,a id hazardous substance? yes No N/A Yes No N/A Dis enser— 1/2 Di enser— I El ❑ Dispenser—3/4 Di enser— Dispenser—5/6 Di ipenser— � Dis enser—7/8 Di enser— 8. Leak detection is properly.located within under-dis enser coni ainment. yes No N/A Ye No N/A Dis enser— 1/2 Di enser— Dis enser—3/4 Di enser— EJ Dis enser—5/6 Di enser— Ll I Li I Dis enser—7/8 Di enser— Yes No N/A Date Done PAPERWORK INSPECTION 9. Monitorin S stem Certification was com leted within the palt 12 months? 11-29-2011 10. Line Leak Detectors were tested/certified within the past 12 m nths? 11-29-2011 lit Spill bucket containment structure testing completed within jhe past 12 months? 11-29-2011 12. Line ti htness testin com leted within the required time fi•am ? 13. Secondary containment tests completed within the required time frame? 2-11-2011 14. Enhanced Leak Detection completed within the required time ame? 15. Other requi testing/maintenance was com letedwithin re ired time frame? List test/m intenance items below.) Describe Test/Maintenance:Air quality St 27&30 1 FS1K Li I Li 1'7,- 1 Describe Test/Maintenance: / FACILITY EMPLOYEE TRAINING Yes No A 1 G. Have alt facilit em to ees received the required on-the-'ob tMining within the past ear? U El 17, Have all facility em to ees hired within the past 30 days recei ed the required on-the-job training.? Note: Explain any"No"answers in the"Comments"section on the f Ilowing page.Those issues require corrective action from the UST owner/operator. UN-057-1/2 www.unidocs.or 9!26/05