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} SP <br />• . <br />UNDERGROUNDSTORAGE T r. : "INSPECTION, <br />E SATA <br />i�aeility Name: <br />t r q �: F' $ 1 { ln�pecttota 41ate>,..; <br />F't{eility Address: t A <br />Name of Designated US"1" Operattnr Conduc n l., r..t.on: Evangelina Barroso-Traylor <br />x <br />international Code Council Certitic-tion No.:520088 UC Expiration Date: 3/30/2017 <br />Sigilature.. t Phone: (909) 455-2275 ext, <br />NIA = not A ticbir <br />Item <br />MONITORING PANEL I AUTHIS°TORY <br />Yes No N/A <br />I , <br />Is the inonitori_n s stern owered on din' o r + - ratiit anode?53, <br />El Li <br />2. <br />Is the monitoring system not currerttl stto` n art Zak Zalarrns? <br />MIR M <br />3. <br />is the Alarm history Report/log for the previous month available, and has it been reviewed by the <br />Desigtlated UST Operator? (Attach a copy of'he a1ca -in Itistoij, r ort,?a to�ectiorr /arart_) <br />4., <br />Has each alarm for the icvitttts month been reVaniW to'spptItp cl '�? <br />C <br />1y <br />US'TSi STEM 1NSd'T:€aT10N <br />5. <br />Are tank -Tap conlainment sumps free of eater. dPbriS and ha?ardous substance? )vnt : 1J the ansirer to hen, =twas )e.,, ':skip <br />to Iteral & Stapips where an olo mt hOu r-c;Rrre d in t+.'a'' j+�sl3! tF.Pni1P 1..tSi be nupected.lif a qualt,7ed servire led mician has not responded to.. and <br />pqiperli, addre=4� the camottfibe alarm, Axu!t,"WA `:i'rms ti c rII i t qp—onrirte service should be atroched to this report. <br />Yes No <br />,Yes <br />Ares <br />*AFo <br />k) <br />Sump Location: : -�°' 5_.. t`tzt ._. ,_ <br />_� <br />❑r <br />1y <br />Sump Location: i ° ' ; Suns Location. <br />'❑ <br />6. <br />Are spill buckets (containment structures) Free of %x -AW, debris, and hazardous substance? <br />Yes NoN/A_ Yes <br />Ilio NIA <br />Tank 2 lD :, i ", Tank 5 ID -F <br />RLL. <br />7. <br />{ire antler-elispens�r containmet;t arz� =ret of eater debrt and hazardous substance? <br />'es . Nrof t Yea No N/A <br />Dis eraser - U? (, Dis enser - 9/10 <br />l)is.enser-3/4 _ Dispenser 11/12 ❑ <br />Dispenser -516 f. I Lj I Lj I Dispenser - 13,114 ❑ ❑ <br />Dis enser- lib 4;D[` I 11 ._y I i)is enser - 15/16 <br />_ <br />$. <br />Leak detection is pro rly located iaithin under -dispenser containment. <br />Yes No ' NIA <br />_ <br />Yes NnYi.4 <br />C)isparser - 1/2 <br />❑,. I [ _ _ <br />ll_ jlcnser - 3/ 1 CJispenser - 11,12 <br />_ <br />Dispenser - 516 ❑ ` ❑ ❑ l Di%pensur - 13/14 <br />Dispenser - 718 [ ® ❑ t Dispenser - 15,16 <br />PAPEKNYORK INSPECTION Yes No Wk <br />Bate Done <br />1. <br />4lonitpring System C ertrttcation vvas completed %vithin the past 12 months? _ <br />� ❑ � ❑ <br />� ❑ <br />` � � ., <br />_ <br />10. <br />line Leak Detectoi:s teste C� .—ralied W111111 the PN 12 months'? <br />1 1. <br />'30111 bucket (containment stlncture) using con feted ��ithin 11ie�st 1< monQt�' t� j_❑ <br />Imo. <br />r-� <br />Line tightness testing' completed wi-hin the required time lYarr)e" U <br />❑ I <br />T';:- <br />Secondary contiinnle nt tests completed within the required t.:l frame? ❑ l 0 ` <br />1 }.Erthauced <br />Le 31 Dtc,jly tee4'o,cotnytime ffaille?W C] ❑ ; __... <br />15. <br />Other ru wid retegtrn ❑ tnn.cn ;tree ,teas earttibleted within rcuired time frame'? rL tst tcst.irrcrirrtertcrttcc iti�itn <br />_ _. <br />.c�ll'Ibc etit i�rl atlntC.tklll�e: ❑ ( ❑ <br />DoscriheTest Maintenance: ❑ ❑ ❑ <br />anmvers in the "Comments' section on the following page. Those issues require corrccti�,c action 1'roni <br />