Laserfiche WebLink
t <br /> Designated Underground Storage Tank (UST) Operator <br /> Monthly Visual Inspection Checklist <br /> Facility Name:H&M Date : 03/07/17 <br /> Facility Address:2501 E.Jackson Ave <br /> City: Escalon Zip Code: 95320 <br /> Designated UST Operator Conducting the Inspection:Karen R Amaiz <br /> International Code Council Certification#: 8356759 Expiration Date: 05/05/17 <br /> Signature: Phone: (209) 518-4836 <br /> Y=Yes,N=No,NA=Not Applicable <br /> Item MONITORING PANEL/ALARM HISTORY Y N NA <br /> 1 Monitoring system is powered on and in proper operating mode. X <br /> 2 Monitoring system is not currently showing an alarms or warnings. X <br /> 3 Alarm history report/log for the previous month is available,and has been reviewed by the X <br /> Desi nated UST Operator. (Attach a copy of the alarm history report/logreport/log to thisform if available.) <br /> 4 Each alarm for the previous month has been responded to appropriately. X <br /> 5 Sensors located in tank-top containment sumps have not alarmed in the past month. X <br /> 5a List all tank-top sumps where alarms occurred in the past month <br /> Note:Sumps where an alarm has occurred in the past month must be inspected unless a qualified service technician responded to,and <br /> properly addressed,the cause of the alarm.Attach documentation verging appropriate service to this report. <br /> I sum ins ection is re wired,record results in item 6,below. <br /> ;�€ <br /> w BUST SYSTEM INSPECTION <br /> 6 Tank-top containment sumps are free of water, debris,and hazardous substance. Sensors are located properly. <br /> Note: Visual inspection o sums is only required in sumps where an alarm has occurred in thepast month or which there is no service record. <br /> Y N Y N <br /> Sump Location: 87 STP X <br /> Sump Location:91 STP X t ` <br /> SuTp Location:Diesel STP X <br /> 7 Spill containment structures are free of water,debris,and hazardous substance. <br /> Y I N INAF Y N NA <br /> Tank 1 —Contents: 87 X Tank 3—Contents:Diesel X <br /> Tank 2—Contents: 91 X <br /> 8 Under-dispenser containment areas are free of water,debris, and hazardous substance. Sensors are located properly. <br /> Y N NA Y N NA <br /> Dispenser 112 X <br /> Dispenser 3/4 X <br /> PAPERWORK INSPECTION Y N NA DATE DONE <br /> 9 Monitoring system certification has been completed within past 12 months. X 07/29/16 <br /> 10 Secondary containment tests have been completed within the required timeframe. X 06/11/14 <br /> 11 Spill containment structure(bucket)testing was completed within the past year. X 07/29/16 <br /> 12 Tank tightness testing was completed within required timeframe. <br /> 13 Line tightness testing was completed within required timeframe. <br /> 14 Other required testing/maintenance was completed within required timeframe. (List test/maintenance items below. <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> FACILITY EMPLOYEE TRAINING Y N NA <br /> 15 All facility employees have received the required on-the-job training within the past year. 06/09/16 X <br /> 16 All facility employees hired within the past 30 days have received the required on-the-job training. X <br /> Note: Any answer of"N"should be explained in the comment section on the following page,and will require <br /> follow-up action. <br /> Page 1 of 2 November 2004 <br />