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'k 0 0 <br />Designated Underground Storage Tank (UST) Operator <br />Monthly Visual Inspection Checklist <br />Facility Name: ConocoPhilli s Site #2705447 <br />Date: 3/21//06 <br />Facility Address: 1469 E. Hammer Ln. <br />City: Stockton <br />Zij Code: 95210 <br />Designated UST O erator Conducting the Inspection: Julie Lee <br />International Code Council Certification #: 5248777 -UC <br />Expiration Date: 12/14/2006 <br />Signature: 14. .sem <br />Phone: (510) 245-5218 <br />Y = 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 o eratin mode. x <br />2 Monitorina 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. Attach a copy of the alarm histoEy report/logreportfiog to thisform if available. <br />4 Each alarm for the previous month has been responded to appropriately. x <br />5 Sensors located in tank -top containment sumps have not alarmed in the past month. x <br />5a _ List all tank -top sumps where alarms occurred in the past month: <br />N/A <br />Note: Sumps where 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 verifying appropriate service to this report. <br />I sum in=n is r uired, 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 of sums is only required in sumps where an alarm has occurred in the East month or which there is no service record. <br />Y N Y I N <br />Sump Location: SuTp Location: <br />Sump Location: SuLng Location: <br />Sump Location: Sum Location. <br />7 Spill containment structures are free of water, debris, and hazardous substance. <br />Y I N NA Y N NA <br />Tank 1 — Contents: 91 x Tank 3 — Contents: 87 x <br />Tank 2 — Contents: 89 x Tank 4 — Contents: Diesel x <br />8 Under -dispenser containment areas are free of water, debris, and hazardous substance. Sensors are located properl . <br />Y N NA YJ N INA <br />Dispenser 112 x Dispenser 9110 x <br />Dispenser 3 / 4 x Dispenser 11 / 12 <br />Dispenser 5 / 6 x Dispenser 13 114 <br />Dispenser 7 / 8 x D is enser 15 / 16 <br />PAPERWORK INSPECTION Y N NA DATE DONE <br />9 Monitoring system certification has been completed within past 12 months. x 5/05/05 <br />10 Secondary containment tests have been co2pleted within the required timeframe. x 9/13/04 <br />11 Spill containment structure bucket testing was coEEleted within the 2ast year. x 5/05/05 <br />12 Tank tightness testin was completed within required timeframe. x <br />13 Line tightness testing was completed within required timeframe. x <br />14 Other re uired testin maintenance was coEEleted within required timeframe. List test/maintenance items below. <br />Test/Maintenance: <br />Test/Maintenance: <br />Test/Maintenance: <br />FACILITY EMPLOYEE TRAINING Y N NA <br />15 All facility em to ees have received the required on -the job training within the past year. x <br />16 All facilLtj em to ees hired within the past 30 days have received the re uired on -the job training- 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 />