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UNDERGROUND STORAGE TANK SYSTEM <br />DESIGNATED UST OPERATOR MONTHLY. INSPECTION REPORT <br />Facility Name: Lodi Food & Liquor <br />MONITORING PANEL / ALARM RISTORY <br />inspection Date: <br />Faoility Address: 1225 Lockford Street <br />IS the Monitoring system powered on and in prRM o2ELting mode? <br />City: Lodi, CA 95240 <br />Name of Designated UST OFemtor ConductingInspection: <br />Is the monitoring sZEtem not currently shoykj anX leak alarms? <br />International Cade Council Certification No.:V� b (9 <br />_U6 <br />Expiration Dated <br />Signature: <br />4. <br />Phone: (916) 371-2380 text. <br />N/® W NNt ®nnlie hla <br />Item <br />MONITORING PANEL / ALARM RISTORY <br />Yes No N/A <br />1. <br />IS the Monitoring system powered on and in prRM o2ELting mode? <br />2. <br />Is the monitoring sZEtem not currently shoykj anX leak alarms? <br />3. <br />Is the Alarm History Report/log for the previous month available, and has it been reviewed by the <br />Designated UST 2gerator9 (Anach a EM c the alarm histo2 ffport4og to this ins eetion orm. <br />4. <br />Has each alarm for the revious month been res nded tea r riate1OWE . <br />UST SYSTEM INSPECTION <br />5. <br />Ate tank -top containr=t sumps fi-ee of water, debris, and hazardous substance? Note: /f the answer to Item 4 was "Yes, " skip <br />to Item 6. Swaps whtlra an alarm has -0sprrrcd' in the past mo di mint be Inspected if a quaty3ed sendce seehn1dan hm not responded to, and <br />ro rl addressed, the mwe of the alar#. Doe a wwo, vert • a ro to service should be attached to dai report. <br />Yet No <br />Sum Location: 91 STIP Sum Sum Location: <br />Sum Location: Su Location: <br />Yet No <br />El I El <br />6. <br />Ares ill buckets containment structures free of water, d®brie and hazardous substance? <br />Yes No N/A I <br />Yes LNo N/A <br />Tank 1 ID - 87 Tante 4 ID- <br />Tank 2 ID - 91 1 Lj I Lj I Tank 5 ID - <br />• <br />Tank'61b­ <br />- <br />7. <br />Are under -die enser. containment areas free of water, debris, and hamdous substance? <br />Yes I No I N/A <br />Yes No N/A <br />- 1/2 - <br />-Dispenser <br />Dis enser -3/4 <br />-Dispenser <br />D' enser -- <br />Dis enser - 5/6 Lj I LJ <br />Dis enser <br />D' Tenser -- 7/8 Lj I n D' r - <br />8. <br />Leak detection is pro2rAX located withizt under -dispenser containment. <br />Yes LNqL/A <br />Yes No N/A <br />Dispenser W 1/2 Dis enser - <br />Dispenser - 3/4 F1 Dispenser - <br />Dis or - 5/6 D' enser -- <br />Dispenser --7/8 Dis enser - <br />PAPERWORK INSPECTION YesI No N/A. <br />Date Done <br />9. <br />Monitoring S stem Certification was oom leted within the past 12 months? <br />11-19-2008 <br />10. <br />Line Leak Detectors were tcstc&certified within the Rut 12 months? Lj <br />11-19-2008 <br />11. <br />Spill bucket containment structnr� testis com feted within the Rast 12 months? Li <br />11-19-2008 <br />12. <br />Line tightness tes!jRS tee!'completed within the Eguired time frame? <br />13. <br />Secan containment tests _completed within the Mquired time frame? <br />1-16-2008 <br />14. <br />Enhanced Leak Detection completed within the nand time frame? <br />15. <br />Other required testingimaintonance was coMElated within required time frame? ist test/maintenance items below. <br />Describe Test/lvlaintcnance: ,air 2LmlE St 27 & 30 <br />12-08-2008 i <br />Describe Test/Maintenance: <br />FACILITY EMPLOYEE TRAINING <br />Yes I No N/A <br />16. <br />Have all facili em la ees reccivod Ike r eared on-the-'ob training within the past ear? <br />17. 1 <br />Have all facilitc 1 ees hired within Ehc East 30 days received the required on -the job traUdn .? <br />Note: Explain any "No" answers in the "Comments'° section on the followine page. Those issues require corrective action from <br />the UST owner/operator. <br />LIN -057 - 1/2 www.uWdecs.org 9/26/05. <br />