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Designated Underground Storage Tank (UST) Operator <br />Monthly Visual Inspection Checklist <br />Facility Name: Mossdale Gas Inc Arco <br />I Date: 10/31/13 <br />Facility Address: 444 Mossdale <br />City: Lathro <br />Zi Code: 95330 <br />Designated U T Operator Conducting the Inspection: Karen R Arnaiz <br />Monitoring system is powered on anroper operating mode. <br />Intemation ode Council Certification # -8032295-UC <br />Expiration Date: 05/31/15 <br />Si a e: <br />Phone: ( 209) 518-4836 <br />Y = Yes, N = No, NA = Not ADolicable <br />Item <br />ORING PANEL / ALARM HISTORY <br />Y N NA <br />1 <br />Monitoring system is powered on anroper operating mode. <br />X <br />2 <br />Monitoring system is not currently showing any alarms or warnings. <br />X <br />3 <br />Alarm history report/log for the previous month is available, and has been reviewed by the <br />Designated UST Operator. Attach a copy of the alarm history report/logreportllog to thisform if available.) <br />X <br />4 <br />1 Each alarm for the previous month has been responded to a ro riatel . <br />X <br />5 <br />Sensors located in tank -top containment sumps have not alarmed in the past month. <br />X <br />5a <br />_ List all tank -top sumps where alarms occurred in the past month: <br />Note: Sumps where an alarm has occurred in the past month must be inspected unless a quaked service technician responded to, and <br />properly addressed, the cause of the alarm. Attach documentation veriMng appropriate service to this report. <br />If sump inspection is required record results in item 6, below. <br />UST SYSTEM INSPECTION <br />6 <br />Tank -top containment sumps are free of water, debris, and hazardous substance. Sensors are located properly. <br />Note: Visual inspection o sums is only re uired in sumps where an alarm has occurred in the past month or which there is no service record <br />Y N <br />Y N <br />SuLnp Location: 87 Turbine X <br />Sump Location: 91 Turbine X <br />Sump Location: Diesel Turbine X <br />7 <br />Spill containment structures are free of water, debris, and hazardous substance. <br />Y I N I NA <br />Y N NA <br />Tank 1 — Contents: 87 X Tank 3 — Contents: Diesel <br />X <br />Tank 2 — Contents: 91 X <br />8 <br />Under -dispenser containment areas are free of water, debris, and hazardous substance. Sensors are located properl . <br />Y N NA <br />Y N NA <br />Dispenser 1 / 2 X Dispenser 9110 <br />X <br />Dispenser 3 / 4 X Dis enser I1 / 12 <br />X <br />Dispenser 5 / 6 X <br />Dispenser 7 / 8 X <br />PAPERWORK INSPECTION Y N NA <br />DATE DONE <br />9 <br />Monitoring system certification has been completed within past 12 months. X <br />07/12/12 <br />10 <br />Secondary containment tests have been completed within the required timeframe. X <br />03/25/13 <br />11 <br />Spill containment structure (bucket testin was completed within the past year. X <br />07/12/12 <br />12 <br />Tank tightness testin was completed within required timeframe. <br />13 <br />Line tightness testing was corn leted within required timeframe. <br />14 <br />Other required testing/maintenance was completed within required timeframe. List test/maintenance items below. <br />Test/Maintenance: <br />Test/Maintenance: <br />Test/Maintenance: <br />FACILITY EMPLOYEE TRAINING <br />Y N NA <br />15 <br />All facility employees have received the required on-the-job training within the past year. 11/08/12 <br />X <br />16 <br />All facility employees hired within the past 30 days have received the required on-the-job training. <br />X <br />Note: Any answer of "N" should be explained in the comment section on the following page, and will require <br />follow-up action. <br />Page 1 of 2 <br />November 2004 <br />