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UNDERGROUND <br />STORAGE <br />DESIGNATED UST OPERATORMONTHLY <br />Facility Nartsc: Lodi Food & 1_iquor InTootion Data: � / M0 <br />Facility Address: 1225 LockfoM street City: Lodi, CA 95240 <br />Nary of Dcsignatcd UST dperator Cctrt4lscting inapeciion: <br />YateAt <br />Co Qr1 %10._111ptudou Dene: .. <br />Y5 ._ <br />Signature:Phone: 016) 371-2380 era, <br />Xteu� <br />MoNiTOMC, #'ANF.1L / HaTosty <br />1 IVBe A %bla <br />Yep No N/A <br />I, <br />7s the monitorrin steal wend on anal ui et o model <br />2. <br />Is the 1404 iitorin sten not currarttiv sho art lastk alarrrts7 <br />3, <br />Ts rite Alarm Mstory Report/lag for the P=ious month eirrail$ble, and hU it Gn reviewed by the <br />� <br />bas UST ? Aach a ea o to alarm 1rt8C0 xe go to I&P iris attars <br />I' 4. <br />Ha each alarm for one rx�ttth n oad�l to l tl ZG 7 <br />:.LIST <br />SYSTEM INSPXCTION <br />-6t <br />5. <br />Acte satlkwtop oquWxwat 8tut�t� ft & 6t water, 4i3Wm, and M, 4`the anrwer to Iron 4 wap "T",' okip <br />N <br />to Amu d. Sum sphere an 21wnl Nae at;Farrod !j, rho post monyh must ba /napeot" Vo qwkArd mrWoo hichnioian has not ras vin" to, aptJ ' <br />f�rP r ad rgg thx CAuse tAi 9lann, �q�yeNpnfodOh�gW�dr! of llrufar .v O7(lQ NO orl,tr•ltrei M t/7ls rvK R�r!- <br />Yet JW <br />Stlltl <br />u y� <br />Yea i®u �'" <br />II <br />I+Ottld9il.A�t}tn: <br />`'"t' <br />Surra Loastion: , $11331 Location; <br />Are & ' 1 b t8 (OMWnment See of www debsis, and e $ <br />r: <br />aN; <br />6. <br />No N/A <br />mauls IYb - F7 T; k 4 IDYi*-2iD=gl <br />,­­ 04SKUAi/A <br />Tt'" <br />6 ID - <br />tr clabrie and ours aubotaacc? <br />YaI NttN!A <br />Yea No N/A I <br />Dijqxnser -- <br />I?ie rises - 3/4D neer - <br />Dig -5 D" - <br />Iile Acer - 7/$ Die slaw - <br />B. <br />Lcals dataWon its le3t *ed within <br />Yep N4 N/A <br />Yet 1\o N/A <br />bis r ,1/2 Ui - <br />r0- ear - 3/4 Dispenser - <br />Dl /6 near - <br />Dis r - 17V Di iezwr <br />P.Ap11W RK jKS?zC r4 Yee No lei/A <br />Dam DoAs <br />4, <br />Cosin tem tion was g2 14"S+ d wl tba 12 zt>onft? <br />11.27.204?' <br />l0. <br />Line Lank 13clWors were tested/cez�ad within the 12 month? <br />11.27.204 <br />11. <br />S 12 basket cortteinruent srrudw tectirl completed within the cast 12 91[ <br />11-'27-2007 <br />12. <br />Lina tightnen tdsthCon1RLgqd within the reaukul tions linins <br />13, <br />Seccm eon tesMCOM 0ed within the s tlired tilue frame? <br />t -a 6.2008 <br />14. <br />Enhagiu4 Leak DeWflon cso feted within die 1i1r4Gi tune frame . <br />--+�+i�--�: <br />5, <br />C r was oorn i®tui within time 7 C Isar tea:tiltsabuema►rce items Calow. <br />Desculbe Taet/Maint rax: it Owility St 271k 30 <br />Dcscrlo Tcsvl4�31Ce; <br />F1i, >� Y o <br />Yee Aho N/A <br />N r Have all fSCtlity loyoes received lira required ou et ear? <br />1.1 <br />I: avt all tltmla ears 10 ea I*ed wittifu the put 30 da s tsainin ? <br />Note: FaVWA UW "W' answers in thaCoatmersth" section as, the falllarving paga. Those ii require coretve action t <br />the UST owner/oporauor, <br />www. <br />[IiT+i' j <br />�. .�», 7C pgVZTL.£9T6 EZ �t1T 600Z/8e/40 <br />VO 39dd 0 Z1NOO>i -inv(j 690Z£££60Z 96:Z0 ££0Z/80/50 <br />