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1171 i - 1: _1F"GE C1 3' <br />43 <br />-Alp, HALTHH EHG1HEEP1HG <br />DESIGNATED UNDERGROUND STORAGE TANK (UST) OPERATOR <br />MONTHLY VISUAL INSPECTION CHECKLIST <br />Facility Name <br />Bonfare Market # 35 Date December 6, 2007 <br />Facility Address <br />15 W. Grant Line Road <br />City, State, Zip <br />Tracy, CA 95376 <br />Designatod Operator <br />Copp, Gregory <br />ICC Certification 4 <br />5278409 -UC Expiration February 16, 2008 <br />Signature <br />Qqr_� e (4:2, - <br />r4 Phone (916) 8263082 <br />Item MONITORING PANEL / ALARM HISTORY <br />Y <br />N <br />NA <br />1 <br />Monitoringmode.---- <br />powered on and in proper operatinq <br />— --- Wff <br />TT <br />2 <br />Monlitoring system is NOT currently showing any alarms or warnings - <br />❑ <br />Y <br />3 <br />Alarm history report / log for the previous month is available, and has been reviewed by the Designated UST Operator. <br />Sump Location: Sump Location: <br />El 1 <br />El <br />39 <br />/S a copy of the alarm histor)l report/ log to this form <br />0 <br />El <br />El <br />;'__4 <br />Each alarm for theprevious month has been responded to appropriately_ <br />01 <br />ff <br />—0 <br />Sensors located in tank -top containment sumps have NOT alarmed in the past month, <br />El <br />Y N NA <br />Tank I - Gasoline - 91 0 M JED Tank Gasoline -87lWaqter <br />Y <br />El <br />L, �5 <br />List all tank -top sumps where alarms occurred in the past month: <br />02121107 <br />El <br />[Vote. Sumps whore an alarm has occurred In the past month must be inspected unless a quallflea service technlclan respondod to, and <br />properly addressed, tho cause of the alarm. Attach documentation verifying appropriate service (o this report. <br />UST SYSTEM INSPECTION <br />. ... ...... <br />6 Tank -top containment sumps are free of water, debris, and hazardous substance. Sensors are located properly. <br />Note: Visual inspection of sumps is only roquIrC10 In sumps t4,here an alarm has occurred in the past month ror which there is no service record <br />9 <br />Monitoring systerin certification has been completed within the past 12 months <br />Y N <br />Y <br />N <br />10 <br />Sump Location: Sump Location: <br />El 1 <br />El <br />E <br />Sump Location Ei 0 Sump Location: i <br />M <br />El <br />Sump Location. El I [I Sump Location <br />El <br />11-1 <br />12 <br />7 Spill Containment Structures are free of water, debris, and hazardous substance. <br />El <br />Y N NA <br />Tank I - Gasoline - 91 0 M JED Tank Gasoline -87lWaqter <br />Y <br />El <br />N <br />0 <br />NA <br />Ll <br />02121107 <br />El <br />14 Other required testing / maintenance was completed within the required timeframe. <br />Test/ Malni!e nonce Air Quality Test <br />Tank2 - Gasoline - 87 Siphon M El <br />❑ <br />0_1 <br />8 Under -dispenser containment areas are free of water, debris, and hazardous substance. Sensors are located properly, <br />171 <br />Y N NA l <br />y i <br />N <br />NA <br />Dispenser I / 2 10 L] F-1 <br />11 <br />Dispenser 3 / 4 <br />Dispenser 5 / 6 ❑ El <br />0 El <br />El <br />0 1 <br />Q <br />FACILITYEMPLOYEE TRAINING Y N NA <br />15 All facility employees have recelved the required on-the-job training within the past year. 0— M_ A 0 d <br />eived the required on -the -lob training. n <br />2N,7 <br />...... Page i <br />. ... ...... <br />PAPERWORK INSPECTION <br />N INA <br />9 <br />Monitoring systerin certification has been completed within the past 12 months <br />12/15/06 <br />WA <br />Ll El <br />10 <br />Secondary containment tests have been completed within the required timeframe. <br />01104/06 <br />E <br />LJ [I <br />11 <br />Spill containment structure (bucket) testing was completed within the post year. <br />12/15/06 <br />0 <br />El C] <br />12 <br />Tank tightness testing was completed within the required timeframe, <br />El <br />0 1 E <br />13 <br />Line tightness testing was completed within the required timeframe. <br />02121107 <br />El <br />14 Other required testing / maintenance was completed within the required timeframe. <br />Test/ Malni!e nonce Air Quality Test <br />(List items below) <br />Test /Maintenance <br />FJ 0 <br />171 <br />FACILITYEMPLOYEE TRAINING Y N NA <br />15 All facility employees have recelved the required on-the-job training within the past year. 0— M_ A 0 d <br />eived the required on -the -lob training. n <br />2N,7 <br />...... Page i <br />