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Designated Underground Storage T (UST) Operator n <br /> Monthly Visual Inspection Checklist JUS <br /> Facility Name:Super St 1?ate: 12P19/09 <br /> Facll' Address:290 N.Main �, e <br /> City:Manteca %i Code:95336 { �� <br /> Desi atcd UST r Conducting lire lbs ion:Karen R Arnalz <br /> International C Counei.l Certification 9:8032295-UC Expiration Date: 06/20/11 <br /> SignbtWVA411'11Phone; 209 51.8-4836 <br /> Y-Y N.N NA a riot A iftbk <br /> itemTORFKG PANEL/ALARM:HISTORY Y N NA <br /> I Mo-nitoiinjt gstern is powered on and in roper operatina mode, X <br /> 2 Monitoring system is not currently showing any alarms or warnings. X <br /> 3 Alarm history mport/log for the previous month is available,and has been reviewed by the X <br /> Desi ated UST razor_ attach u c a the alarm hist re la to thisform i available. <br /> 4 Each alarm for the prmous month has bean responded to appmrjately. X <br /> 5 Sensors located in tante to containment sum ,'have not alarmed in the past month, X <br /> Sa List all tank-top sumps where alarms occurred in the ptzs7 month: <br /> Note:Safips where an alarm hos oww"d to die past month must be tnspectad unleses a gwl�W wrviee rrehnklan d ta,and <br /> pP"r/yaddresNd,Mm Caum of lite alarm.Attach doewmniation var&ng appropriate service to this report. <br /> t 004revion is fret,ecc d resatrs fn/tem ti Lcluev, <br /> „ VST SYSTEM INSPECTION <br /> 6 Tank-top containment sumps are free of water,debris,and hazardous substance. Sensors are located properly_ <br /> Now;Visual Lnqvvtftm!VI. Is only irer!in, s where an alarm has occurred in thdp=rn mth or whtah there it na xrvice racarcC <br /> Y N - Y N <br /> .Sum t„ocation:91 Turbine X <br /> SumpLocation: Diesel Turbine X <br /> ". <br /> Sump Location;87 Turbine X <br /> 7Sal containment structures are free of water,debris,and hazardous substance, <br /> Y IN I NA I —Y——N—j-Y—F-N—j KA <br /> Tank 1-Contents:91 Ix I I Tank 3-Contents:87 X <br /> Tank 2-Contents.Dievel I I X 1. <br /> 8 Under-di mscr containment areas are free of water,debris,and hazardous substance. Sensors are located pro i . <br /> Y N I NA Y N I NA <br /> Dispenser 112 X Dispenser 9/10 X <br /> Dis ►tser 3/4 X 2isR cnser 11/12 X <br /> Disneer S/6 X <br /> Dis enscr 718 X <br /> PAPERWORK INSPECTION Y N I NA DATE DONF, <br /> 9 Monitoring system ccrtifcatiort has been completed within past 12 months, X 05/27/09 <br /> 10 Secondn containment tests have been com leted within the re aired timeframe, X 07/21/09 <br /> 1.I Spill containment structure Qncket testing was completed within the Cast ear, X 05/27/09 <br /> 112 Tank fi)jhtness testing was completed within rcqyired timeframe. X <br /> 13 Line ti tness testing was completed within re uired timeframe. X <br /> t4 Other required testis maintenance was com feted within rcqyired timoframo. (List test/maintenu v Items below. <br /> TestlMaintenance: <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> FACILITY EMPLOYEE TRAINING Y --N——NA <br /> 15 All facility employees have received the"eq ired on-the=ob training within the ear.03/27/09 X <br /> 16 Ail facili em M fes hired within the past 30 da s have received the re iced on-the-'ob training. X <br /> Note: Any answer of"N"should be explanted in the comment section on the followings page,and will require <br /> follow-up action. <br /> Pagc 1 oft Novembcr2004 <br /> t7/2'd M7289t7602T:01 WOdA Zb:$T " 6002-2-Nnf <br />