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SWrage Tank <br /> Ma"VmW . n <br /> Rer.IMM011 <br /> „x <br /> Month: OCTOBER Year: 2015 <br /> PTO Exp. na . <br /> FA0012979 12/31/2013 y LANCE YORK <br /> PILOT/ FLYING J - LODI#617 5296385-VC / AVGV5T 12, 2016 <br /> Fadft UST rre tar. F gnatim. <br /> PILOT/FLYING J JOS JIMENEZ <br /> FadkAdclresv <br /> pEStGJygl <br /> 15100 THORNTON RD. ��tCE Yp� <br /> LOOT, CA 95242 <br /> Na <br /> 209 339-4066 <br /> ta,za�s <br /> yi <br /> A UST Designated Operator(DO),who possesses a current"California UST <br /> System Operator"must conduct a monthly certificationI inspecissued tion of o International <br /> US sT ystem.a Council(ICC) r�0 <br /> The DO must provide a copy of this monthly visual inspection checklist to the <br /> UST Owner or operator. <br /> The DO(mut alert the UST Owner or Operator of any condition discovered <br /> during the monthly visual inspection that may require p actions. <br /> The UST Owner or Operator must maintain a copy of this monthly visual <br /> inspection checklist and all attachments for theprev2 months. <br /> The <br /> must be maintained ,or,if approvedby Unified Program <br /> Ago CUPA or their designats.off-sits at a readity available location. <br /> 1. Is the monitoring system powered on and in the proper operating mode(i.e.,functional and not )? J' ❑ ❑ <br /> 2. Does the nwnkodng system show current alanns or warnings(i.e.,"all functions normar)? M ❑ ❑ <br /> 3. Is an alarm history report or log for the previous month available and has it been reviewed by the 00? IM <br /> m Vaca s wfyna�, ❑ ❑ <br /> d <br /> 4. Has each environmental alarm for the previous month been responded to appropriately,according to the <br /> response log and/or maintenance s?(Nara: aWms such astir paper reptecawmit,printer ora,low ❑ ❑ <br /> a Ne( ,ff b in do r bb dc). q�Z1 <br /> No onvirmwerset aimm since led rm on <br /> 5. Have Vg tank-top containment sump sensor alarms been triggered within the past month? 9 ❑ ❑ <br /> 5a. List all tank-top sump alarms triggered In the posit month below ~service recooft for eam alum ) <br /> 777 0 No record <br /> ❑No <br /> O No record <br /> ❑No record <br /> ❑No recom <br /> ❑No record <br /> For any sump alarms noted in 5a above with no record of a qualified service technician response,answer questions S and Sa below. WA <br /> S. Are tank-top sumps presently free of water,debris,and ea. Are tank-tor sump probes P (i.e.,at <br /> hazardous substances? lowest point It sump)? <br /> Was Canand comments saw to rot•addbonal deta#&as needem ruse General Coffunents section to r as needsol <br /> IMMUNE <br /> ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ 1101 N <br /> ❑ 1 ❑ ❑ 1 ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ <br /> JUN 0 3 2016 <br /> t <br />