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1612 W. Hammer Ln, Stockton, CA 95209 <br />5/17/16 <br />March 2016 D.O report with D.0 not listed <br />Monthly Visual Inspection Checklist` <br />C 1612WHA61 ' <br />Date: 3/14/2016' <br />12 til' Hammer Lane <br />Cl ;,StocktonZip Code: 95209 <br />besi n.tted h ST _p aror nducti g the Inspection: 'Laura Gomez <br />ntcrr.atw 'our i ion #: 8344748 Expiration Date: 4/1412017 <br />atur F Pbuuc: (949) 460.5200 <br />- Y Yes, N = No NA =Nor ,a alic.l <br />cm <br />NIO TO NG PANEL / ALARM HLSTORY � Y i A , rA <br />]' N <br />M nrno� n r h} ttm r Pow red on ind. properoperating mode <br />�\(onitoiiopsystetnrsmotcunentlpshawungany alarms orwarvuX <br />Alarm history report;lok for the previous month is available, and has been reviewed by the Designated UST X <br />. <br />Operator. (Atwell a copy of the almnt histol) reporu[og to this form if available.) <br />4' <br />.`c:"e <br />Each alarm for the has been <br />Sump Location: "tA <br />previous month responded to appropriately, X- , <br />5 <br />— -- <br />Sensors located in.tank-top containment sumps have not alarmed in the month. <br />5a <br />past X <br />- List all tank -top sumps where alarms' occurred in the past month: <br />NIA a x <br />n;rA <br />Note: Sumps where an alar has occurred. in the past oionth must be i mpeal d nnlc e a qualified se,wce tech tic rmu respond <br />SpiII con to nnnentstructures are free ofwater, debris, and hazardous` substance <br />addressed, the cause gfthe alarm Attach docurnentatirn verifying app, oprr rtr_,ci, ice ro rhis report fsun+p ra. pec iron is _ <br />tri it 6, below, ,. <br />OR <br />UST SYSTEM INSPECTION - ....,4 <br />6 Tank -top containment sumps are free ofwater, debris, and hazardous substance. Sensors are Located properly`, <br />Test/rLfnuucnrnne' <br />i'esI'lblaurtuwnt e�..� <br />j � l z stLA�farructrarac e <br />'EMPLOYEE TRAINING <br />Record ID PR0231127 <br />PHOTO #1 <br />s i ff e <br />wr �, <br />Fatinah Zareef, REHS Page 1 of 2 <br />]' N <br />i <br />Sump Location: "'A <br />.Sump Location: .-A <br />Sump Location: "tA <br />Sump Location. "�' <br />Sump Location: "'A " <br />Sump Location: ave <br />n;rA <br />7 <br />SpiII con to nnnentstructures are free ofwater, debris, and hazardous` substance <br />Y N NA <br />" <br />i <br />I Tank -87 <br />X <br />_T <br />:Tank -Diesel � <br />� <br />8 <br />_ <br />Undo' dispenser containment areas are free of water, debris, and hazardous substance. semsa-s ate tocated tiro] <br />Y N ' NA <br />XDispense, <br />-314 x <br />LXw, <br />h X - <br />PAPERWORK INSPECTION Y <br />N <br />ti A <br />MOtlltarllfg sytit'tri certification has l)ecn completed within j7aJC"I ,,. X <br />0 <br />containment tests have been completed within the r" <br />i l <br />SpillCOntairuneut stractare (bucket[ testin fire pas X <br />i2 <br />Tank 6glancss testim, was completed wttlnn , , gi •lite. <br />}( <br />-t i' <br />rim; tighten» tc ting was completed within teyuaed timerranie <br />X <br />)( <br />14 <br />— <br />Outer required rusting/ntauttcnatnce was completed within required timetiaure.:List tesuntaintcnau <br />Test/rLfnuucnrnne' <br />i'esI'lblaurtuwnt e�..� <br />j � l z stLA�farructrarac e <br />'EMPLOYEE TRAINING <br />Record ID PR0231127 <br />PHOTO #1 <br />s i ff e <br />wr �, <br />Fatinah Zareef, REHS Page 1 of 2 <br />