COMPLIANCE INFO_2009-2015 - Laserfiche WebLink

Home Browse Search

UNDE GROUND STO �GE TAR SYSTEM 'DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT i Facility Name: Lodi Food & Liquor Inspection Date: Facility Address: 1225 Lockford Street City: Lodi, CA 95240 Name of Designated UST Operator Conducting Inspection: , International Code Council Certification No.: U C ! Expiration Date: ( O 2 fr i Signature: Phone: (916) 371-2380 ext. N/A=Not Ap licable Item MONITORING PANE RM HISTORY Yes No N/A 1. Is the monitoring system powered on and in proper operating ode? Eir.❑ ❑ 2. Is the monitoring system not currently showing any leak alarm' ? y ❑ 3. Is the Alarm History Report/log for the previous month availa le,and has it been reviewed by the ❑ ❑ Designated UST Operator? (Attach a copy of the alarm histo . re ort/lo to this ins ection orm) 4. Has each alarm for the previous month been res onded to a o riatel ? ❑ ❑ UST SYSTEM INSP CTION 5. Are tank-top containment sumps free of water,debris,and haz rd substance? Note:If the ansiver to Item 4 was "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 properly addressed,the cause of the alarm. Documentation verifying appropriate service should be attached to this re ort. Yes I No Ye! No Sump Location: ❑ ❑ SumpLocation: Sum Location: 011 ❑ Su Location: ❑ ❑ £ 6. Are spill 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— ❑ ❑ ❑ Tank 2ID-91 ❑ ❑ T k51D— ❑ ❑ ❑ Tank 3 ID—DSL ❑ I ❑ I T 6 ID_ ❑ ❑ ❑ 7. Are under-dispenser containment areas free of water,debris,a d hazardous substance? Yes No I N/A I Yes No N/A Dispenser— 1/2 ❑ 10 Di enser— ❑ ❑ ❑ Dispenser—3/4 ❑ ❑ Di3penser— ❑ ❑ ❑ Dispenser—5/6 ❑ I ❑ Dis enser— ❑ ❑ ❑ Dispenser—7/8 ❑ I ❑ Dispenser— ❑ ❑ ❑ 8. Leak detection is properly located within under-dis enser con aimnent. Yes,I No N/A Yes No N/A Dispenser— 1/2 ❑ ❑ 1 Di enser— ❑ I ❑ 1 ❑ Dispenser—3/4 ❑ ❑ Di 3penser— ❑ ❑ ❑ Dispenser—5/6 ❑ ❑ I Di 3penser— ❑ ❑ ❑ Dispenser—7/8 W1 ❑ ❑ I Di penser— El El ❑ 14 Z:`-rk PAPERWORK INSPECTION Yes No N/A Date Done 9. MonitoringSystem Certification was completed within the past 12 months? ❑ El11-29-2011 10. Line Leak Detectors were tested/certified within the past 12 months? ❑ ❑ 11-29-2011 11. Spill bucket(containment structure)testing completed within he past 12 months? ❑ F-111-29-2011 12. Line ti htness testin com leted within the re uired time fram ? 1013. Secondarycontainment tests completed within the required ti e frame? F-1 [:12-11-2011 14. Enhanced Leak Detection completed within the required time ame? ❑ ❑ 191, 15. Other required testing/maintenance was completed within reqt ired time frame? (List test/m intenance items below.) Describe Test/Maintenance:Air Quality St 27&30 E21 ❑ ❑ Describe Test/Maintenance: ❑ I ❑ FACILITY EMPLOYEE TRAINING Yes No /A 16. Have all facilityemployees received the required on-the-job training within the past ear? El 17. Have all facility employees hired within the past 30 da s recei ed the required on-the job training.? ❑ ❑ Note: Explain any"No" answers in the"Comments"section on the following page. Those issues require corrective action from the UST owner/operator. UN-057-1/2 www.unidocs.or 9/26/05