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Monthly Designated Operator Inspections Rev: t l/ (949) 458-USTO (8786) Month: DECEMBER Year: 2012 CUPA Facility ID #: PTO Exp. Date: DO Inspection Date: Designated UST Operator nduchng the nspecton: FA0006672 12/31/2012 iL +3 w t Z LANCE YORK International Code Coi ncil CerU (cation # and Expiration Date: Facility Name: PILOT/ FLYING J -RIPON #618 5296385 -UC / SEPTEMBER 1, 2014 DO Stamp and Signature: Facility UST Owner/ Operator. Facility Contac. PILOT /FLYING J BRIAN CAIRNS List all tank -top sump alarms triggered in the past month below: (Attach service records for each alarm response) ❑ �- t U.) 1-1,5 :47 gP,-pE • ❑ No record Facility Address: it t ';— ❑ No record 1501 JACK TONE P.D. L - lZ Vc, L,G{ ='ANtJ L#.(-- Lo LIQ, $0 t t -Lt tZ:" 1 l3; ?,A a Godu t5 RIPON, CA 95366 — ❑ ❑ Contact Phone #:1 (209) 599-4141 ChecklistInstructions: A UST Designated Operator (DO), who possesses a current "California UST ,% , �f System Operator" certification issued by the International Code Council (ICC) e. must conduct a monthly visual inspection of the UST system. 13 No record 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 Signa a of esignated 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 of Inspection Agency CUPA or their designate, off-site at a readily available location. 1. e e e e Is the monitoring system powered on and in the proper operating mode (i.e., functional and not bypassed)? -�;i i ❑ ❑ 2. Does the monitoring system show no current alarms or warnings (i.e., "all functions normal")? 12� ❑ ❑ 3. is an alarm history report or log for the previous month available and has it been reviewed by the DO? * 97 "Attach a copy of the Alarm History ReporNLog to the VIC if available. If not 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 papa replacement, printer error, low ® ❑ ❑ product, fuel delivery needed, and invalid fuel level, if related to low product in the tank do not need to be logged. All 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? ❑ c9l. ❑ 5a. List all tank -top sump alarms triggered in the past month below: (Attach service records for each alarm response) ❑ �- t U.) 1-1,5 :47 gP,-pE • ❑ No record ❑ it t ';— ❑ No record ❑ L - lZ Vc, L,G{ ='ANtJ L#.(-- Lo LIQ, $0 t t -Lt tZ:" 1 l3; ?,A a Godu t5 ❑ No record — ❑ ❑ (-- 7.'5 Ott. -WATlaCt_ ?' ' 1�0eL 'k— t-Z,j z 16,11 -18:W J j&jjCX -v 19 Os -z- ❑ No record ❑ ❑ ❑ L• Z—t _C111- I? ti ❑ No record L ZB DtSp lit M - tjC2� -CA £ Qui e2 z- tt3=2r- 23. z1 13 No record For , 6. r -•r -a -n n�=:=rr��tca�� -- -* &IMS 5/3+(13 by Ly. i 0 •- e ny sump alarms noted in 5a above with no record of a qualified service technician response, answer questions 6 and 6a below. N/A>�F 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) ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ — ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ -* &IMS 5/3+(13 by Ly. i 0