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UNDERGROUND STORAGE TANK SYSTEM <br />DESIGNATED UST 0PE1UTOR MONTHLY INSPECTION REPORT <br />jj Fwiiity t1ame; Lodi Food & Liquor -m <br />Facility Addles&. 1225 Lwktord Street City: Lodi, CA 55240 �T~ <br />Nam® of Uasigamd UST Operator Conducting inspection; <br />irttem.a,tonal Code couneff7orif, cationNo,; �' ri=.xparetion Dart, L 1:j <br />Signature; / 4 --- r ph lle .' <br />• i i:996j 371-7.360 ext, <br />VA itol n ri.,,ti <br />lter� M0NIT0.-RING PANEL/ ALARM HISTORY es, do <br />N/A <br />1, is the nsorutol'i119 sy: tc_m Powered_oil Anel in proper Op@rrt°in rn4dr7 v�. — tt <br />1s the rtcotlftQri1ff V-sWm nut eurrontly showing any leak alarms? �N!_ i <br />3. is the A.lann History Report/log for the previous month available. and has it been reviewed by vile <br />Designated i.STOperator? fAuaeh ag2py ofehe utarrrr history eworill'ok re, Mix trrx ev ion orm. i <br />4. Has each alarm for the previous month been tes ended tom ria:el ? <br />LUST SYSTEM INSPECTION <br />Are tank -top containment semis free of water, debris, and hazardous substance? More. ,yrho 4nsw#r to Ilem 4 irks "Yea, " skip <br />ra !tf+n 5. SuNvr Merle an we -M ba: tecurrud in the posy month insert be rwectea rf a qua! and mrvlct irohniCiGR has nor r a <br />oto r acklresved. rhe ecus# oidia Warm. rJocu�„ nlativn sort t c r tote 90 rr� ah�uld b® G:tasri o this r(o�rprt^ '° re d tam prJ <br />I Yea No _ Y 1 leo <br />SLocariori— Sum Lotat <br />utr Ion <br />Suit i.ogattgn: - <br />Sump Locatloni <br />N 6, I Aim spill bacfidis �containrnent tructures free of water, debris, avid ha`atdous substance' <br />�Tc1tY� 'D <br />; — �� Tank 4 Ila - <br />_Cank <br />3 ID - 91 lank S U) - <br />Tank 3 ID - DSL 7a41c 61b - <br />Areunser-diseonaer containment at. free <br />_.__. �as debris, andgc <br />substae? <br />7. <br />—.%water _hamrdous __ _ <br />aa' s No N/A _ T ilea <br />D iv enser — 1/2 r7=l7is�Cnr <br />— <br />Dis e.saer— 3/4 ETAis unser •� '� <br />I]iR unser— 5/6 Gisn3er <br />_Hist — 718 _ -� --`- <br />D21112L?it FnSier� <br />Le detcctioa; is pro er�tcd wltitln tnder�dis <br />8. <br />lies Ao N/A � .�` Y,yy <br />Dis ensu-� 1/2 Dis cnser <br />_Disp®Haim - 9/G Dis neer --6 <br />I}is enser-5/8 i�1s eraser- <br />Dis enser—f I Mtins,nSRr — <br />y. _ tixrrttoring system cartificadori was cerin) eie� wi'�61n vile asst i2 months? <br />- <br />16, Lipiieak bete 1 --�--- 11.23-20'iQ <br />Detectors were tostir<cl/cer:11•Sed within the est ►2 months'? _ <br />I t. S ii! bllcittt corrttilntiant structuft tutin a Com leted within tile past l?,montlts? 11-23-2010 <br />11-23-C p <br />12. Linz ti tiltnee:a tasting completed w1rhin t,ya re uirect time fru_ ma? <br />13. Secoaids e411tailln ont tests OOM 10W widlin the re uu-ed til frame' -- 1-18�i?tN�B <br />lit. Enhanced Leak Detection com lead within, the re uired time frame? -� <br />1 S. Other re aired it,stirl 'Malnteitatica was co leted within rcrauired time frame? (List lesr/rnaintenandn items below <br />i <br />Doscr{be Test/it+Ialiltenattee: Alr uality St 27 & 30 11-fi <br />�Dcsoribe Tvst/Maintvnanee; <br />FACI1Lf'Y EMPLOYEMIRING Ya5 Nig NIAi 6. 'Have al: fkcihtY =Dloyees received the, ner{,QV4 oil -vire -lob ttaittin,�,withan tilt pari yaaa" �� <br />17, Have a!l faccfity erXaplo Hired within tilt est 30 d!Ls received the aired ort -the-' 4btrsitrlili ? " <br />Mote, Explain aRy "No° answers in the "Comments" section on the fallowing page. Thosc issues require oorractive action from <br />the USI` owner/bperateir. <br />UN,057 - 'W wrvw,Nniduca.ors 9126APS <br />