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Designated Underground Storage Tank (UST) Operator <br />2009 Monthly Visual Inspection Checklist... <br />r,rmrir� rrT^r11u'71CATArTDnXTA4T�WTAT. CFRVTCES <br />Facility Name: OLYMPIAN / NELLA # 427 <br />Item MONITORING <br />Date: MAY 19, 2009 <br />Facility Address: 33130 WATERLOO ROAD <br />City: STOCKTON, CA <br />Zi Code: 9j205 <br />Designated UST or Conductin the Inspection- DAN ZEMAN <br />Dis enser• 3 ! 4 Dispenser: 11//12 <br />internacional Code Council Certification #: 5243781 -UC <br />E iration Date: MARCH 3, 2011 <br />Dispenser: 516 enser. <br />Phone: (530) 681)-2,05 <br />Si lure: <br />Y ffi yes, N = No, D1A —_Not Applicable <br />PANEL/ ALARM HISTORY Y N NA <br />1 Monitoring -stem is powered on and in proper operating mode - <br />Monitoring astem is not currentl • showing an y alarms or warnin s. X <br />3 Alarm history report/log for the previous month is available, and has been reviewed by the �C <br />Designated UST Operator. (Attach a copy c tlx alarm histo re )ort/lo tv t/us forret i available-) x <br />4 Each alanp for the previous month has been res nded to aMopriately. <br />5 Sensors located m tank -to containment sumps have not alarmed in the past month. t ?� <br />?a - List all tank -top sumps where alarms occurred in the past month: <br />.Note: Sumps w.hcre an alarm It s occurred in the past munth must be inspected unless a qualified service technician respundcd tv, and <br />properly addressed, the cause of the alarm. Attach ducumentaaon verifying appropriate service to this report. <br />1 sum ins ection is required, record results in item 6, below <br />UST SYSTEM INSPECTION <br />6 Tank -top containment sumps are free of water, debris, and hazardous substance. Sensors are located properly. <br />.Note: 6 isual Ins ction v sum s is vnly rc /red to um s where an alarm has occurred in theEast munch or whic4 there is rev service record. <br />Y N Y N : <br />Sum Location: .Sum Location: <br />Sum Location: Sump Location: <br />Sump Location: Sum Location: <br />7 Spill containment structures are free of water, debris, and biwardous substance. <br />Y N NA Y N NA <br />Tank i — Contents: UNLEADED • Y_ Tank 3 — Contents. DIESEL X <br />Tank 2 — Contents: Q -ts.12- Tank 4 — Contents: X <br />8 Under -dispenser containment areas are free of water, debris, and hazardous substance. Sensors are located ro rl -. <br />Y I N I NA I I Y IN NA <br />Page 1 of 2 <br />- -� Nd ££ 8b L 6007-/7-VZl :Ole(] Z/l :96ed umou�un :wot-1 <br />November 2004 <br />Dispenser: 1 t t 6 <br />" <br />K <br />Dispenser: 2 X Dispenser: 9110 <br />Dis enser• 3 ! 4 Dispenser: 11//12 <br />Dispenser: 516 enser. <br />X <br />PAPERWORK INSPECTION Y N NA <br />DATE DONE <br />9 <br />Monitorin 'stem certification has been completed within past 12 months. X <br />12/3/2008 <br />10 <br />Secondary containment tests have been com feted within the r aired. timeframe. X <br />5/2008 <br />11 <br />Sill containment structure (bucket) testing was completed within the past year. X <br />12/3/2008 <br />12 <br />Line leak detector testing was completed within reg uired timeframe. X <br />12/3/2008 <br />13 <br />Line tightness testing was completed within required timeframe. X <br />14 <br />Other r aired testing/maintenance was com feted within required timeframe. (List testlntaintenance items below.) <br />TestlMaintenance: VAPOR RECOVERY TESTING ` X1/2009 <br />Tes04aintenance: ISD START UP X <br />3/262009 <br />Test,.Maintenance,: X <br />FACILITY EMPLOYEE TRAINING <br />Y N NA <br />15 <br />All facility em fo ees have received the r aired on-the-'ob trainin within the st 'ear. <br />X <br />16 <br />All facility employees hired within the past 30 da -s have received the required on-the-'ob 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 />- -� Nd ££ 8b L 6007-/7-VZl :Ole(] Z/l :96ed umou�un :wot-1 <br />November 2004 <br />