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UNDERGROUND STORAGrE TANK SYSTEM DESIGNATED UST OPERATOR. MONTHLY INSPECTION REPORT Facility Name: Lodi Food & Liquor I spection 7Date: .j,—/9 Z /Z Facility Address: 1225 Lockford Street tty: LodName of Designated UST Operator Conducting Inspection: WZ International Code Council Certification No.: ( z _ on Date: _. Phone: (916) 371-2380 ext. Signature: N/A=Not A licable MONITORING PAW/ALARM HISTORY Yes No N/A Item ❑ 1, is the moni oring systemowered on and in ro er o eratin m de? ❑ 2. Is the mollitorina s stem not current! showin an leak alarms ❑ 3. Is the Alarm History Report/log for the previous month availab e,and has it been reviewed by the Designated US'r O erator? Attach a co o the alarm histo re ort/lo to this ins ection orm. 4. Has each alarm for the rUK evious month been res onded to appropriately? skip UST SYSTEM INSI' CTION 5. Ace tank top containment sumps free of water,debris,and haz rdous substance? ,vote:�frhe ans,ver to/rein a,vas"Yes," and to!tern 6.Suutps inhere an alarm has occurred ht the past month must be t spected tf a qualtfied service techntciun has not responded to urr ro erl addressed,die cause o the alarm.Documentation vert in a�n•o r late servfce should be attached to this r•e ort. Ye: NO Ye; No Sum Location: Su Location: ❑ ` Sump Location: Sul np Location: 6. Ares ill buckets(containment structures)free of water,debris and hazardous substance? Yes No N/A nk i lU Yes No N/A — Ta —87 Ta&4 ID— �— Tank 2 1D—91—_!—^ _- Ta k 5 ID— Tank 3 IU— � 'f a k ti IIS"— � ❑ ❑ 7. Are under-dispenser containment areas free of water,debris,ai id hazardous substance. Yes No N/A _ Yes No N/A El Dis enser— 1/2 Di enser— - Dispenser—3/4Di enser— —� Dieer— ❑ Q Dins Dispenser--5/6 ns ` I Dis enser—7/8 eer— 8. Leak detection is p operly located within under-dis enser cont inment. yes NoN/A i yes I No N/A. _ Di enser— E—Ey- Dispenser enser— 1/2 El E-111 —3/4 � Di enser— Dispenser—5/6 Di enser— ❑ ❑ Dispenser 7/8 Di enser— :,�>...�,�. PAPERWORK INSPECTION - 9. Monitoring System Certification was completed within th_e a t 12 months? 11-29-2011 11-29-2011 10. Line Leak Detectors were tested/certified within the past 12 n onths? 11-29-2011 11. Spill bucket(containment structure testin com leted within he ast 12 months? 12. Line tightness testing coin leted within the re uired time frac e? 2-11-2011 13. Secondary containment tests corn leted within the re uired time frame? 14. Enhanced Leak Detection completed within the re uired time frame? 15. Other required testing/maintenance was completed within required time frame? List test/maintenance items below.) Describe Test/Maintenance:Air guality St 27&30 --- 12-22-2011 Describe Test/Maintenance: :._ :. ... 777, Yes No N/A FACILITY EMPLOYGI TRAINING i6. Have all facilit em to ees received the re uired on-the-ob t ainin within the past ear? 17. Have all facilit em to ees hired within the ast 30 da s rcce ved the required on-the-job training. .? Note: Explain any"No" answers in the"Comments"section on the llowing page.Those issues require corrective action from the UST owner/operator. 9/26/0- UN-057-1/2 www.unidors.or