COMPLIANCE INFO_2008-2012 - Laserfiche WebLink

Home Browse Search

Designated Underground Storage Tank (UST) Operator Monthly Visual Insvection Checklist Facility Name: H&M Date: 09/13/11 Facility Address: 2501 E. Jackson Ave N NA DATE DONE City: Escalon Zip Code: 95320 Designated UST Operator Conducting the Inspection: Karen R Arnaiz 07/13/11 International Code Council Certification #: 8032295 -UC Expiration Date: 06/11/13 Signature: Phone:( 209 ) 518-4836 I = Y C9 Ir — Plu, i Ul H I own..1C Item MONITORING PANEL / ALARM HISTORY Y N NA 1 Monitoring system y is powered on andm , in proper operating mode. X 2 Monitoring system is not currently showing any alarms or warnings. X 3 Alarm history report/log for the previous month is available, and has been reviewed by the X Designated UST Operator. Attach a copy of the alarm histoty report/logreportllog to thisform if available. 4 Each alarm for the previous month has been responded to appropriately. X 5 Sensors located in tank -top containment sumps have not alarmed in the past month, X 5a - List all tank -top sumps where alarms occurred in the past month: Note: Sumps inhere an alarm has occurred in the past month must be inspected unless a qualified service technician responded to, and properly addressed, the cause of the alarm. Attach documentation verging appropriate service to this report. ffSamD inspection is reauired record results in Item 6, below. UST SYSTEM INSPECTION 6 Tank -top containment sumps are free of water, debris, and hazardous substance, Sensors are located properly, Note.' Visual Inspection o sums is only re aired in sumps where an alarm has occurred in the past month or which there is no service record Y N Y N SuTp Location: 87 STP X Sump Location: 91 STP X Sump Location: Diesel STP X 7 Spill containment structures are free of water, debris, and hazardous substance. Y N NA Y N NA Tank I — Contents: 87 X Tank 3 — Contents: Diesel X Tank 2 — Contents: 91 X 8 Under -dispenser containment areas are free of water, debris, and hazardous substance. Sensors are located properly. Y N NA Y N NA Dispenser 1 / 2 X Dispenser 3 / 4 X 13 Line tightness testing was completed within required timeframe. 14 Other required testing/maintenance was completed within required timeframe. List test/maintenance items below. Test/Malmenance: Test/Maintenance: Test/Maintenance: FACILITY EMPLOYEE TRAINING Y N NA 15 All facility employees have received the required on-the-job training within the past year. 06/20/11 X 1 16 1 All facility employees hired within the past 30 days have received the required on -the fob training. I I I x 1 Note: Any answer of "N" should be explained in the comment section on the following page, and will require follow-up action. Page 1 of 2 November 2004 PAPERWORK INSPECTION Y N NA DATE DONE 9 Monitoring system certification has been completed within past 12 months. X 07/13/11 10 Secondary containment tests have been completed within the required timeframe. X 06/09/11 11 S ill containment structure (bucket) testing was completed within the past year. X 07/13/11 17 To..L +;nh+na o taotin • e nmmnia+aA iniirhin ranniraA 4imc.frame 13 Line tightness testing was completed within required timeframe. 14 Other required testing/maintenance was completed within required timeframe. List test/maintenance items below. Test/Malmenance: Test/Maintenance: Test/Maintenance: FACILITY EMPLOYEE TRAINING Y N NA 15 All facility employees have received the required on-the-job training within the past year. 06/20/11 X 1 16 1 All facility employees hired within the past 30 days have received the required on -the fob training. I I I x 1 Note: Any answer of "N" should be explained in the comment section on the following page, and will require follow-up action. Page 1 of 2 November 2004