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UndergrOLKW MMageTa 39-PFJ-617 OpWdtKW Monft Vinal ' n C) monthly Designated Operator Inspections Rev.'11/18/2011 (949)458•USTO(8786) MOnth.T JANUARY Year: 2014 ?A Facility I PTO ExD.Date: DORnspecton ate: Designated UST Operator Conducting theInspection: FA0012979 12/31/2013 -jp. Z3 ,UA LANCE YORK Facility Name: international a Council Ceffication#and Expiration ate: PILOT/ FLYING J - LODI x#617 5296385-UC / SEPTEMBER 1, 2014 Facility UST OwnerI Operator Facility Contact; DO Stamp and Signature., PILOT /FLYING J JOSE JIMENQ , actll'—F�ty Address: /Q'� ypt10E 15100 THORNTON P.D. LODI, CA 95242 ;;d U Exp8"Pt � i Contact Phone#: i j (209) 339-4066 Checklist instructions. A UST Designated Operator(DO),who possesses a current"California UST i System Operator"certification issued by the International Code Council(ICC) 4°c tF04 must conduct a monthly visual inspection of the UST system. 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 inspection checklist and all attachments for the previous 12 months.The records pnatltre of D ted Operator i must be maintained on-site,or,if approved by the local Certified Unified Program Confi Inspection LAgency(CUPA)or their designate,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)? ❑ ❑ 2. Does the monitoring system show a3 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 ReporYLxq to the Vic if evadable.if rot available,explain why not in Genual Commanis 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 replacernera.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 as tank-top containment sump sensor alarms been triggered within the past month? ❑ O 52. Ust all tank-top sump alarms triggered In the past month below. (Attach service records for each alarm response) ❑ 7Zo No record I $- l-1$ ❑ No record I PX-51P1� 5. Q, LLD, t ! Z ❑ No record L -2 �sL.' Z- al�Nt�tArt-• QA-�A iz t2� S:SZ - :�O c�� Z7`fZ� ❑ No record i.MWJDED 5 7.m t loLY ❑ 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 P4 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 rote additional details as needed) (Use General Comments section to rote additional details as needed) ❑ ❑ ❑ ❑ ❑ ET- 0 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ >< a ❑ ❑ ❑ o 11❑ ❑ 0 ❑ ❑ ❑ ❑ ❑ 0 ❑ ❑ ❑