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39-PFJ 618 Underground Storage Tank(UST)Designated cOperator Inspection Checklist(VIC) tvlonthty Designated Operator Inspections Rev:11/!8/201! (949)458-USTO(8786) Month: AUGUST Year: 2014 UPA F86ility 10 : PTO Exp.Date: DO Inspection ate: Designated USTOperator Conducting theInspection: FA 6672 12/31/2013 'ILt3C, of LANCE YORK Facility Name: International Code Council Ce ca'on and Expiration ate: PILOT/ FLYING J - RIPON #618 5296385-UC / SEPTEMBER 1, 2014 Facility U er .Operator. Facility Contact DO Stamp and Signature: PILOT /FLYING J BRIAN CAIRNS aciNty Address: 1501 JACK TONE RD. Q� `pNGE�Gq� 0 RIPON, CA 95366 w Contact Phone#: U No.5296385 U Exp.Sept.1,2014 0 � (209 599-4141 �? t) Checkist Instructions: A r A UST Designated Operator(DO),who possesses a current`California UST S� ngprt�` d System Operator"certification issued by the International Code Council(ICC) must conduct a monthly visual inspection of the UST system. Q FO The DO must provide a copy of this monthly visual inspection checklist to the FCAl3 a 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. j 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 S' a of Designated Operator must be maintained on-site,or,if approved by the local Certified Unified Program C firmation of Inspection Agency( CUPA)or their desi nate off-site at a readily available location. 1. Is the monitoring system powered on and in the proper operating mode(i.e.,functional and not bypassed)? ( j ❑ ❑ 2. Does the monitoring system show no current alarms or warnings(i.e.,"all functions normal")? ❑ ❑ 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 Repo-Vtog 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 El El 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 00 inspection on 5. Have U2 tank-top containment sump sensor alarms been triggered within the past month? ❑ 15� ❑ 5a. List all tank top sump alarms triggered in the past month below: (Attach service records for each alarm response) ❑ SIOF-) - Co No record 5L.. Z-AJSN_ N 4 t Q . A ` 7 3 t ❑No record IDic,P �O M - A.-- S.t} 8 tC1 tvo0- (o lit Qa`( 'T+e;'ftra ❑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 R 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 nota additional details as needed) (Use General ts 'qn to_rwta additiona6 s as needed) Y • • ❑ _❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ IN 2 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ r__K, El ❑ ❑ ❑ ❑ ❑ ❑ ❑ 1 Vol- 0 J a': ❑ ❑ 0 ❑ ❑ 0