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s 39-PFJ 618 Tank(M)DesignaW Pth�Designated Operator Inspections _ _ Rev:11/18/2011 (949)458-USTO(8786) Month: NOVEMBER Year: 2014 PA Facility ID#: PTO Exo.Date: nspecti te: Designated U T Operator Conducting the Inspection: FA 6672 12/31/20LANCE YORK Facility Name: International Code Council certificaton Wand xplratton ate: PILOT/ FLYING J - RIPON #618 5296385-VC I_dVGVST 12, 2016 Facility UST Owner/Operator. Facility Contact: DO Stamp and Sig Q r PILOT /FLYING J BRIAN CAIRNS �.dG� y 4, N aci dye' Add 1501 JACK TONE RD.RrPat s ON, CA 95366 , ® a Contact Phone#: (209) 599-4141 r U\ sChecklist Instructions: r� ®Q► Z A UST Designated Operator(DO),who possesses a current"California UST OF CA Q System Operator"certification issued by the International Code Council(ICC) must conduct a monthly visual inspection of the UST system. 1!J 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 o during the monthly visual inspection that may require follow-up actions. V The UST Owner or Operator must maintain a copy of this monthly visual inspection checklist and all attachments for the previous 12 months.The records Signatu of ignated Operator must be maintained on-site,or,if approved by the local Certified Untied Program C fi tion of Inspection Agency CUPA or their desi nate,off-site at a readilyavailable location. 1. Is the monitoring system powered on and in the proper operating mode(i.e.,functional and not bypassed)? N C1 ❑ 2. Does the monitoring system show no current alarms or warnings(i.e.,"ail functions normal")? vg ❑�❑ 3. Is an alarm history report or log for the previous month available and has 4 been reviewed by the DO?' �0 ❑ ❑ 'Attach a copy of the Alarm History Reporhl.og to the VIC if available.If not available,explain why Trot 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 paper 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? ❑ 19 ❑ 5a. List all tank-top sump alarms triggered in the past month below: T (Attach service records for each alarm response) ❑ t0 L-tt0 (3t0 Wep tywo- t'=A . tf tttq®P *rww--W%4104�, WrAle. © No record -�- -S- SM- FA t 3 1Zt � t'0.q- Z5 13No 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. N/A V5- 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 rote additional details as needed) 77 • ® e -7 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 01 ❑ ❑ ❑ ❑ ❑ ❑ L ____L_ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 0 0 ❑ « jRn