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�� mWSTTvf� P� <br /> Designated Underground Storage Tank (UST) Operator­ r D <br /> Monthly Visual Inspection Checklist <br /> Facility Name: Ramos Oil#18 Date: 8/22/2013 <br /> Facility Address: 10842 South Harlan Road <br /> City: French Camp,CA Zip Code: wr , ,�„- f -�.� /e <br /> Designated UST Operator Conducting the Inspection: Tim Adams x , <br /> International Code Council Certification#: 8205730 Expiration Date: 5/8/2015 N <br /> Signature: Phone: 925-551-4777 <br /> V=Yes,N=No,NA=Not Applicable <br /> Item MONITORING PANEL/ALARM HISTORY Y N NA <br /> 1 Monitoring system is powered on and in proper operating mode. x <br /> 2 Monitoring system is not currently showing any alarms or warnings. x <br /> 3 Alarm history report/log for the previous month is available,and has been reviewed by the x <br /> Designated UST Operator. (Attached a copy of the alarm history report/log to this form if available.) x <br /> 4 Each alarm for the pervious months has been responded to appropriately. x <br /> 5 Sensors located in tank-top containment sumps have not alarmed in the past month. x <br /> a - List all tank-top sumps where alarms occurred in the past month: <br /> Note:Sumps inhere an alarm has occurred in the past month must be inspected unless a qualified service technician responded to,and <br /> properly addressed,the cause of the alarm.Attach documentation verging appropriate service to this report. <br /> If sump inspection 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: Visual inspection ofsumps is only required in sumps where an alarm has occurred in the past month for ivhich there is no service record. <br /> Y N Y N <br /> Sump Location: Sump Location: <br /> Sump Location: Sump Location: <br /> Sump Location: Sump Location: <br /> 7 Spill containment structures are free of water, debris,and hazardous substance. <br /> Y N NA Y N NA <br /> Tank 1 -Contents: Diesel x Tank 3-Contents: x <br /> Tank 2-Contents: x Tank 4-Contents: x <br /> 8 Under-dispenser containment areas are free of water, debris,and hazardous substance. Sensors are located roperly. <br /> Y N NA Y N NA <br /> Dispenser]a x Dispenser 4a/5a x <br /> Dispenser 112 x Dispenser 5 x <br /> Dispenser 2a/3a x Dispenser 13/14 x <br /> Dispenser 3/4 x Dispenser 15116 1 1 1 x <br /> PAPERWORK INSPECTION Y N NA DATE DONE <br /> 9 Monitoring system certification has been completed within past 12 months. x 10/30/2012 <br /> 10 Secondary containment tests have been completed within the required timeframe, x 12/16/2011 <br /> 11 Spill containment structure(bucket)testing was completed within the past year. x 10/30/2012 <br /> 12 Tank tightness testing was completed within required timeframe. x <br /> 13 Line tightness testing was completed within required timeframe. x <br /> 14 Other required testing/maintenance was completed within required timeframe. (List test/maintenance items below) <br /> Test/Maintenance: Air Quality <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> FACILITY EMPOYEE TRAINING Y N NA <br /> 15 All facility employees have received the required on-the-job training within the past year. <br /> 16 JAII facility employees hired within the past 30 days have received the required on-the-job training. <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 />