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UNDERGROUND STORAGE TANK SYSTEM DESIGNATED UST OPERATOR MONTHLY INSPECTION REPORT Facility Name:� "Y Inspection Date: T"Icil _a�,u,JrE_ss M_7� r. C litity Name of Desi noted UST Operator Conducting Inspection: Evangelina Barroso-Traylor International Code Council Certification No.: 8200889 -UC Fxpifation Date: 3/10/2017 Phone: si (909) 455-2275 ext. LttL) e2b---�8 , —C." -Li� _LLL____j N; A — WA Usable Yes Item MONITORING PANEL / ALARM HISTORY Yi; No N/A 1, Is the monitoring system powered oil and in proper operating niode? -9 ---3, . I Is the monitoringsystem not curnantlyshowing an leak alarms? 3. Is the Alai -in I listory Report/log fior the previous triontli available, and has it been reviewed by the ❑ Desi%znated UST Operator? (Amish it copi, of the alm-ni history report, etion forinj 4. Flas each alarm for tic previous month been responded to appropriately? UST SYSTEM INSPECTION 5, 1Are tank -top containment sumps free of water, debris, and hazardous substance? Note: If the rtnrtrer to Irem 4 lsas Ile,, SRI) to Irem 6. Simsps There air alarm ha:< occurred or the lictst month miat be inspected if iiiialijimiservice lechniciao has not respondvo' to. mid ------------- PAPERWORK INSPIRCTION Yes; No NIA Date Done onitor n_ comp g System Certification was completed within the post 12 months' 10. Linu Leak Detectors acre iestedkertihed within thepast 12 months? 11. Spill bucket (COIll,'linnICIlt Structure) les!ilally --on, 12. Linc tightness test in�onrpletett within rbc rqtared time trams13, Secondary containment tests com leled within the rbc eared three Crame? ❑ 14, Enhanced Leak Dctectioll eorllpleLeLt Within [lie requited Linic Frame? ED] bet(okr.) 15� i Other required test ing,1ria ii itenaric c was completed within re aired time frame'.,' (Vyi test/im Dcscribe TeSl: 'vlaintenariee: El 0+ 5 Describe TestiAlaintemince: FACILITY RNIPLOYEE TRAINING Y s No N/A I jave iIII facility elliployees received the required on -the -sob training within the past year, ❑ [T El .1,7.- lave all filicililty umplu�VeeShirv(I Within the [last 30day.s received Elie required Note: any "No" answers in the "Comments" SeQLion on the following page. Those issues require corrective action from the UST ovvner/operator. UN -051 - 1/2 9/21015 Is Docimlentelti oil verl, Ving e1ppropl-rote Yes Yes Sump Weation: Sump Location: `A Sump Location: J , Sun?p Location; 0. Are spill buckets (contairuncut stirttictur slfree of water; debris, and hazardous substance? Yes No N/A Yes V Tank I ID - m. =1 Tank Tank 2 i R, i 0 T E] Tank 4 [D - T-, ink 5 ID - El E In ' k lj:�:___ a n k, 3 D - Tank 6 ID . . .... . ...... 7 Are under-dis minerit areas free of water, pelpser containment debris, and hazardous substance.-, Yes 14 Dispenser -I/" J Dispenser 3/4 R/A IN/— Dispenser 9110 I1/12 Yes No N/A ❑ Dispenser - 5/6 ❑ Dispenser- 13/14 Dispenser - 7/8 Dispewer- i 511 8. Lcak detection is properly, located within under-dis eraser containment. N/A Yes No N/A D isensu - 112 Dispenser 9/10 eraser _>i4_ ❑ Dispenser 11 i'l 2 ❑ EF_M _Drs Dispenser - S4 E E Dispenser - IV - I)ispenser 7/8 _Dispenser _ - 15�16 nL --P ------------- PAPERWORK INSPIRCTION Yes; No NIA Date Done onitor n_ comp g System Certification was completed within the post 12 months' 10. Linu Leak Detectors acre iestedkertihed within thepast 12 months? 11. Spill bucket (COIll,'linnICIlt Structure) les!ilally --on, 12. Linc tightness test in�onrpletett within rbc rqtared time trams13, Secondary containment tests com leled within the rbc eared three Crame? ❑ 14, Enhanced Leak Dctectioll eorllpleLeLt Within [lie requited Linic Frame? ED] bet(okr.) 15� i Other required test ing,1ria ii itenaric c was completed within re aired time frame'.,' (Vyi test/im Dcscribe TeSl: 'vlaintenariee: El 0+ 5 Describe TestiAlaintemince: FACILITY RNIPLOYEE TRAINING Y s No N/A I jave iIII facility elliployees received the required on -the -sob training within the past year, ❑ [T El .1,7.- lave all filicililty umplu�VeeShirv(I Within the [last 30day.s received Elie required Note: any "No" answers in the "Comments" SeQLion on the following page. Those issues require corrective action from the UST ovvner/operator. UN -051 - 1/2 9/21015 Is