|
Dc s i ,Tuated Un d, erground Storage Tank (UST) Operator
<br />Monfl,flv Visual Inspection Checklist
<br />facility ity Name� f
<br />a�cil _�'l
<br />Date: 11,10/13
<br />_Facility Address'. 2-5,011
<br />J <ickson, Ave
<br />City: Escalon .......... . .
<br />Z- Code: 95320
<br />S O
<br />D esignated US— �r) or C', 11
<br />Conducting the r��cR
<br />e lnstion: Karen Arnaiz
<br />International Code Cotmc�!
<br />Certiltc—ation A.- 8-�72'295-UC Expiration Date: 05%311'15
<br />SianatUre: . .
<br />. ........ . .... Phone: ( 209) 518-4836
<br />x 08/08/13
<br />x06/09/ t I
<br />X 08/08113
<br />test/maimenance itents below.)
<br />Y N NA
<br />vear. 06/03/13 x
<br />x
<br />e -lob training.
<br />Y to N= NAO�
<br />—INIONITO—RINC
<br />Not A
<br />plicable
<br />Mena i
<br />i['ANEL/ALARM HISTORY Y
<br />N
<br />NA
<br />Ii II aS
<br />I Monitoring sys
<br />m i's o%erect oil and 'I 'jgweroperating mode. x
<br />ii i\ eIj
<br />..
<br />Ietcd witiiin tli,: re(.I ir..ed Lijnefrane,
<br />..... ..—
<br />2 Monitoring, sy,
<br />iz'm is ii ot currentiv showing, any alarms or warnim-,s.
<br />x
<br />cas completeti tiket! i n i lie l),)St verir.
<br />ilk
<br />3 Alarm Iiistory for dw previ,�-011111 is available. 1-inct has been reviewed by the x
<br />cmi ilctt i
<br />.,1:e�qfaired time fiame.
<br />131
<br />--!�e sianatedU.Sl
<br />W�r,or. jorm if arvailahle
<br />—i ""' I .7
<br />t]tcinlc.
<br />WICY R1M
<br />s4 ,s month n�,sponded toappropriat��
<br />alarm !'ori Epch . ... . ....
<br />x
<br />5 Sensors
<br />�1 .rJl to 3 cantainni, a slim ps have not aklrmki in t'ISt Illontil,
<br />-5a Lim qjjips where alarms occurred in the past im',m1h:
<br />\-('Ie, Si .. ? ,s
<br />- 'Wr", r!I .lar In has occurred in the past month must be ins peaedunless a qualified service technician respond edio, and
<br />....... . . ........
<br />e ofthe af:a,mdocumntafiuirsexljyurt appropowe service Iii Ilia report.
<br />�]Pl-,OYEETRAININC;
<br />Ii
<br />. . ......... - ...........
<br />All C�acihi\
<br />..... . .........
<br />`,n,e receive,� die r.,,,irired
<br />on-ille-iobtr�lininu within tile P�
<br />...... . ...
<br />— - - - ---------
<br />.......... .
<br />- - - - - - - - - - - - - - - - - - - -
<br />i7-14 SYSTEM INSPECTION
<br />6 1 'Fank-top C(,).l t'l
<br />11, 1 --Inlps are fro:, of :iter, debris, and liazardous; substance. Sensors are located properly.
<br />where unalavm b IS 0- Urre'l In the I ust month or which there is YPoservice record
<br />N V N
<br />.............. ... .
<br />. .............. .
<br />".Vll
<br />ar" lrcc r, debris, and lin/irdoits ��tthstance.
<br />febt
<br />N 1 NAj Y N
<br />NA
<br />Tank I
<br />.f...... ..... .......
<br />ome)Us: Diesel
<br />Tank 2 Coz,,,;,
<br />x
<br />. . . .......
<br />8. find
<br />I IMInQ1,11 areWs �,e� Of water, debris, and hazardous substance. Sensors are located rope Y-
<br />.... . . . . .....
<br />TA Y N
<br />NA
<br />D, of SO* 3/,'
<br />..... .....
<br />- ... ..... ............. ..... ........... . ..
<br />x 08/08/13
<br />x06/09/ t I
<br />X 08/08113
<br />test/maimenance itents below.)
<br />Y N NA
<br />vear. 06/03/13 x
<br />x
<br />e -lob training.
<br />PA FIP,'O,�ORK
<br />INSPECTION
<br />9
<br />1 Nray nitnri)IL
<br />Ii II aS
<br />)e�el witldn m�t 12 mont!)so L
<br />10
<br />ii i\ eIj
<br />..
<br />Ietcd witiiin tli,: re(.I ir..ed Lijnefrane,
<br />..... ..—
<br />(bit k
<br />cas completeti tiket! i n i lie l),)St verir.
<br />ilk
<br />Tlrk t i i-, hui s
<br />cmi ilctt i
<br />.,1:e�qfaired time fiame.
<br />131
<br />11 Eli,
<br />t'hjfl,re�LIIap��tifll
<br />t]tcinlc.
<br />WICY R1M
<br />-1}t 1 Ir ""Is comnleted
<br />- - -- - . .... ........... ............ . . .........
<br />timeframe.(L
<br />Y
<br />....... . . ........
<br />FAC" IIN
<br />�]Pl-,OYEETRAININC;
<br />Ii
<br />. . ......... - ...........
<br />All C�acihi\
<br />..... . .........
<br />`,n,e receive,� die r.,,,irired
<br />on-ille-iobtr�lininu within tile P�
<br />...... . ...
<br />— - - - ---------
<br />.... .............
<br />w i t I i i n is
<br />>tl days have r" e; \ ed the req u ired on
<br />x 08/08/13
<br />x06/09/ t I
<br />X 08/08113
<br />test/maimenance itents below.)
<br />Y N NA
<br />vear. 06/03/13 x
<br />x
<br />e -lob training.
<br />
|