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4- <br /> 0 <br /> M N <br /> r N <br /> � t3 <br /> M <br /> N a <br /> O <br /> ) LO LNDERGR©UND STORAGE TANK (UST) OPERAT6R_ <br /> 0 <br /> MONTHLY VISUAL INSPECTION CHECKLIST <br /> N Oulk Stop Market#1.3$ <br /> wool 1153 Lincoln Blvd, oar„ September 16,2015 <br /> t, Tracy,CA 95376 <br /> ope sw Carpenter,Curtis <br /> :aetabe°"a 816786"C <br /> Expiration March 20,201S <br /> Phone (916)825-7857 <br /> _ Qj <br /> MONITORING PANEL I ALARM HISTORY __ Y N NA <br /> ...mug system is powered on arid in proper operating made. <br /> O <br /> system is NOT currently showing any alarmsor warnings - --- --- ❑■ ❑ C <br /> ■ O O <br /> " Alarm history report 1 log for the previous month is available,and has been reviewed by the Designated UST Operator. / ❑_ ❑ � <br /> h a�y 01 the al—history report/ o <br /> tog ro this torm7 � ❑ ❑ — <br /> EsO alarm for the previous month has been responded to appropriately _. ■ ❑ ❑ E <br /> Sensors located intanN-top containment sumps have NOT alarmed in the past month. - ❑ ■ ❑ N <br /> kesl alit rank-top sumps where alarms occurred in the past month: (D <br /> —— <br /> ptt pettsaas alarmed on&19.75 due to annual MSC.L8 alarmed on&31-15 <br /> O <br /> Ali* Swn%- wham an alarm rias 00wred in the past month rrmst be mspecfed unless a quaMbd service technioen responded to.and t1 <br /> poparlyaddressed.Me cause clime alarm. ANeh documentation vsn4gng appropnafe srrvze to this meport -- <br /> a ars ems OW,record results m item a beau. ' U <br /> UST SYSTEM INSPECTION �V <br /> TaMr tfrR containment sumps ate free of water,debris,and hazardous Substance. Sensors are located property. <br /> Nam t"tsiral mspeChOn orsumps Alonly required m sumps whara an alarm has occ~mete pad month br which thane IS no service to=$ »- W <br /> YI N I I YI NI t1t <br /> Sump Lm~ 9f Annual ■ ❑ I Sump Location: I ❑ I ❑ 0 <br /> Slow Location ❑ ❑ 1 Sump Location � ❑ ❑ <br /> SOW Location' ❑ ❑ j Sump Location: ❑ <br /> 1 <br /> Bpi Conisifxrtent Structures are free of water,debris,and hazardous substance.JY N❑ NA O <br /> rw*2- Gasoline 89 ■ ❑ © Tank3- Gasrolfrtegt [] <br /> Y N NACL <br /> ■ IN <br /> Vf4wdoperiser containment areas ate five of water,debris,and hazardous substance. Sensors are located properly. <br /> Y N NA <br /> 17147sasw 112 { ■ ❑ O { I o <br /> to <br /> to <br /> m <br /> „ PAPERWORK INSPECTION 08/19115 1 ■ N i NA <br /> _ - <br /> n ilea trees ,r�mpteled within the Past 12 months - 11yen .xtmpleted within the required timeframe <br /> 04(29114 ■ ❑1❑ <br /> « 08/19/15 ■ ❑ ❑ <br /> t+ng was r�[rmpteted within the Past year. _ <br /> L) ;Fin the required timeframe <br /> M p _ <br /> N the required bmeharneVale <br /> completed within the required timeframe (LW items bet <br /> _P. .. <br /> . 08/02114 ■ _❑ ❑ <br /> �f Tew+t - � ❑ � ❑ 1 ❑ � <br /> mCn <br /> _.-. Y N NA <br /> L) Q CILITY EMPLOYEE TRAINING . �J W <br /> J the required on-the-job training within the past year W <br /> Cl) <br /> �.❑ ❑ ■ <br /> tr') U ' est 30 days have recewed the regwred on-the-lab training,- � <br /> Page 1 Chechtist Y l <br /> Qm <br /> 0 .S <br /> tn O <br /> ,�ra� 0 <br />