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Monthly Designated Operator Inspections (949) 458-USTO (8786) • r rr rI I rI lyVAj 15 t;,:jr car Month: DECEMBER L Year:1 2012 CUPA Facility ID #: P70 Exp. Date: DO Inspection Date: Designated US7 Aerator Conducting theInspection: FA0006672 12/31/2012L t3• Z oez LANCE YORK International Code Council Certl (cation # and Expiration Date: Facility Name: PILOT/ FLYING J - RIPON #618 5296385 -UC / 1, 2014 Facility UST Ownerl Operator. Facility Contact: _SEPTEMBER DO Stamp and Slgnature: PILOT /FLYING J BRIAN CAIRNS ❑ Facility Address: 1501 JACK TONE P.D. ❑ RIPON, CA 95366 ❑ No record Contact Phone #: (209) 599-4141 '� t• Ci0- ! r�1 i c - =a ' ' I r `{ 4 Checklist Instructions: _ — --- A UST Designated Operator (DO), who possesses a current "California USTr.:- ` ;f System Operator" certification issued bthe International Code Council (ICC) q: ` "° • Y= " must conduct a monthly visual inspection of the UST system. ❑ The DO must provide a copy of this monthly visual inspection checklist to the .^ UST Owner or Operator. The DO must alert the UST Owner or Operator of any condition discovered during the monthly visual inspection that may require follow-up actions. The UST Owner or Operator must maintain a copy of this monthly visual "r Signa)ire of,0esignaled Operator inspection checklist and all attachments for the previous 12 months. The records must be maintained on-site, or, if approved by the local Certified Unified Program onfi tion otInspection Agency CUPA) or their designate, off site at a readily available location. 1. • • e s Is the monitoring system powered on and in the proper operating mode (i.e., functional and not bypassed)? � ❑ ❑ 2. Does the monitoring system show no current alarms or warnings (i.e., "all functions normal")? 0. ❑ ❑ 3. Is an alarm history report or tog for the previous month available and has it been reviewed by the DO? ' 95.1 'Attach a copy of the Alarm History Reporlk.og to the V!C it available. snot available, explain why not in General Comments section. ❑ ❑ 4. Has each environmental alarm for the previous month been responded to appropriately, according to the response log and/or maintenance records? (NOTE Non -environmental alarms such as for pape<reptacemem, printer error, tow (9 ❑ ❑ product, fuel delivery needed, and Invalid fuel level, if related to low product in the tank do not need to be logged. M others do). No environmental alarms since last DO inspection on 5. Have no tank -top containment sump sensor alarms been triggered within the past month? ❑ C�- ❑ 5a. List all tank -top sump alarms triggered in the past month below: (Attach service records for each alarm response) ❑ L t -? (P 1 t - 1b QTP Q 0 E I:A =3 2 - lju y�A P cojefr-- pep A.,Le. O No record ❑ L. t -r - V5,— Ste. - F A. U t$ Z=51 WpEt"i✓t_ -y6nwJvp 0 No record ❑ L- 12 irrL,,A-_P"tjw-W-, La ua.5o I Zl (Z." 13:'Zo j C0d,,01$ b t`j ❑ No record ❑ LS OI OC -L At- CZZ- l =l7 0=W j 60jC -• tclOG -1, 0 No record ❑ L•Z"t 1>16r?to 5 vow- 5•U.w lZZ i7;SS 0Norecord ❑ L ZS 1)r SP totm�SQi�_FA.£ Dt.t� 12 10=zr-23=z1 f,,%^% -)T. —)IfZ4�- 0N record For ; 6. L^ r��►��•��-�=�fII��S�►JIYJ�i�7��Y"a/Kf•'fl��'�'� -* N AGI,-� 5/Skj t3 bq L -y. e e my sump alarms noted in 5a above with no record of a qualified service technician response, answer questions 6 and 6a below. N/AjW Are tank -top sumps presently free of water, debris, and 6a. Are tank -top sump probes presently properly located (i.e., at hazardous substances? lowest point in sump)? (Use General Comments section to rote additional details as needed) (Use General Comments section to note additional details as needed) ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ :❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ -* N AGI,-� 5/Skj t3 bq L -y.