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SOUTHERN CALIFORNIA,,, nderground SWrdge Tank (UST) Designated Monthly Designated Operator Inspections (949) 45&USTO (8786) Rev: 11/18!2011 Month: MARCH Year: 2013 UPA Facility ID #: PTO Exp. Date: DO Inspection Date: Designated UST Operator Conducting the Inspection: FA0006672 12/31/2012 t poz tom} , 2ot 3 LANCE YORK FacilityName: International Code Council Certification # and Expiration Date: PILOT/ FLYING J - RIPON #618 5296385 -VC / SEPTEMBER 1, 2014 Facility UST Owner! Operator Facility Contact: DO Stamp and Signature: PILOT /FLYING J BRIAN CAIRNS vg GNAT�cO Facility Address: 1501 JACK TONE RD. p10 O.o ,cEYOrt RIPON, CA 95366 CLu 9 9gg85 �C Q Contact Phone #: (209) 599-4141 y,2ota ExP �I SeQt c+ ChecklistInstructions: "California A UST Designated Operator (DO), who possesses a current UST System Operator" certification issued by the International Code Council (ICC) ly inspection T UND Sp� must conduct a visual t system. 5. The O must provide a copy of this monthlyvis vhe isual inspection checklist to the OF Cb�ti% 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 sgnated Operator inspection checklist and all attachments for the previous 12 months. The recordsignature must be maintained on-site, or, if approved by the local Certified Unified Program Con fi on of Inspection Agency CUPA or their designate, off-site at a readily available location. ❑ No record For any sump alarms noted in 5a above with no record of a qualified service technician response, answer questions 6 and 6a below. NIA ❑ 6. Are tank -top sumps presently free of water, debris, and 6a. Are tank -top sump probes presently properly located (i.e., at hazardous substances? 1. Is the monitoring system powered on and in the proper operating mode (i.e., functional and not bypassed)? �d ❑ ❑ 2. Does the monitoring system show no current alarms or warnings (i.e., "all functions normal'? PiL ❑ ❑ 3. Is an alarm history report or log for the previous month available and has it been reviewed by the DO?' �( ❑ ❑ _.... ❑ ❑ ❑ Attach a copy of the Alarm History Report/Log to the VIC if available. If not available, explain why not in General Comments section. I ❑ 4. Has each environmental alarm for the previous month been responded to appropriately, according to the response log andlor maintenance records? (NOTE: Non -environmental alarms such as for paper replacement, printer error, low �I ❑ ❑ 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 oo inspection on 5. Have no tank -top containment sump sensor alarms been triggered within the past month? ❑ 5a. List all tank -top sump alarms triggered in the past month below: (Attach service records for each alarm response) ® se. • fi- • • ® e••• • e L - � t a - I��N FV 3 1 O L - o ill ❑ No record VE .W.ICI lj 77 (�-(r��No record ❑ No record ❑ No record ❑ No record No record For any sump alarms noted in 5a above with no record of a qualified service technician response, answer questions 6 and 6a below. NIA ❑ 6. 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 note additional details as needed) (Use General Comments section to note additional details as needed) ❑ ❑ ❑ _.... ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 4 PAeWND5D 5(31(!3 Aly L.YWz-- U