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Designated Underground Storage Tank (UST) Operator <br />Monthly Visual Insnection Checklist <br />Facility Name: Ramos Oil #18 <br />Date: 8/22/2013 <br />Facility Address: 10842 South Harlan Road <br />City: French Camp, CA <br />Zip Code: <br />Designated UST Operator Conducting the Inspection: <br />Tim Adams <br />international Code Council Certification:: 8205730 <br />Expiration Date: 5/8/2015 <br />Signature: <br />Phone: 925-551-4777 <br />t t .N Y = Vcs. N = No. NA = Not AnmtcaDlc <br />Item I <br />MONITORING PANEL/ALARM HISTORY <br />Y N NA <br />I <br />Monitoring system is powered on and in proper 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 />x <br />Designated UST Operator. (flttached a copy of the alarm history report/tog to this form if available) <br />x <br />4 <br />Each alarm for the pervious months has been responded to appropriately. <br />x <br />5 <br />Sensors located in tank -top containment sumps have not alarmed in the past month. <br />x <br />a <br />- List all tank -top sumps where alarms occurred in the past month: <br />Note: Sumps inhere an alarin has occurred in the past month nmst be inspected unless a qualified service technician responded to, and <br />properly addressed, the cause of the alarm. dtiach documentation verEying appropriate service to this report. <br />1f sump inspection is required, record results in itein 6, below. <br />UST SYSTEM INSPECTION <br />6 <br />Tank -top containment sumps are free of water, debris, and har_ardous substance. Sensors are located properly. <br />Wore: visual inspection of sumps is only required in sumps where an alarm has occurred in the past month for which there is no service record <br />Y I N <br />Sump Location: <br />Y N <br />Sump Location: <br />Sump Location: <br />Sump Location: <br />Sump Location: <br />Sump Location: <br />7 <br />Spill containment structures are free of water, debris, and hazardous substance. <br />Y N NA <br />Y N NA <br />Tank I - Contents: Diesel x I Tank 3 - Contents: <br />x <br />Tank 2 - Contents: z I Tank 4 -Contents: <br />x <br />8 <br />Under -dispenser containment areas are free of water, debris, and hazardous substance. Sensors are located properly. <br />Y N NA <br />Y N NA <br />Dispenser la x Dispenser 4a / 5a <br />x <br />Dispenser 1/ 2 x Dispenser 5 <br />x <br />Dispenser 2a / 3a x Dispenser 13 / 14 <br />x <br />Dispenser 3/ 4 1 x Dispenser 15 / l 6 <br />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 />10/30/2012 <br />10 <br />Secondary containment tests have been completed within the required timeframe. x <br />12/16/2011 <br />11 <br />Spil I containment structure (bucket) testing was completed within the past year. x <br />10/30/2012 <br />12 <br />Tank tightness testing was completed within required timeframe. x <br />13 <br />Line tightness testing was completed within required timeframe. x <br />14 <br />Other required testing/maintenance was completed within required timeframe. (List lesdmaintenance items below.) <br />Test4fainienance: Air Quality <br />Test/A4aintenance: <br />_j <br />Test/Maintenance: <br />FACILITY EMPOYEE TRAINING <br />Y N NA <br />15 <br />All facility employees have received the required on-the-job training within the past year. <br />16 <br />1 All 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 />