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Site Number: Month : September <br /> TOT <br /> Designated Underground Storage Tank ( UST) Operator <br /> Monthly Visual Inspection Checklist <br /> Facility Name : EI Dorado Food Mart — <br /> Facility Address : 1901 South EI Dorado Ave. <br /> City: Stockton JZip Code: 95206 <br /> Designated UST Operator Conduction the Inspection: Randall Kirb <br /> Internatioinal CodA Council Certificatioli # 50566-UC — Ex iration Date: 10/23119 <br /> Si nature : Phone : 916 870-5932 <br /> Y = Yes, N = No, NA = Not Applicable <br /> Item MONITORING PANEL i ALARM HISTORY Y N I N/A <br /> . .: . #z,,^. .., ,. ,= > Ems .., r .._e,.5 ., _F �, -* . <br /> A; �.�..,. 'rrt <br /> 1 Monitoring system is powered on and in proper operating mode . <br /> 2 Monitoring system is not currently showing any alarms or warnings , <br /> 3 Alarm history report/log for the previous month is available, and has been reviewed by the <br /> Designated UST Operator, (Attach a copy of the alram history reportAog to this form if available.) <br /> 4 Each alarm for the previous month has been responded to appropriately. �50 <br /> 5 Sensors located in tank,*top containment sumps have not alarmed in the past month . <br /> 5a List all tank-top sumps where alarms occurred in the past month: <br /> i- -1 CTe� <br /> Note: Sumps where an alarm has occurred in the past month must be inspected unless a qualified service technician responded to, <br /> and properly addressed, the cause of the alarm. Attach documentation verifying appropirate service to this report. <br /> if sump inspection is required, record results in item 6, below. <br /> 77 <br /> UST <br /> UST SYSTEM INSPECTION <br /> 6 Tank-top containment sumps are free of water, debris , and hazardous substance. Sensors are located properly. <br /> Note: Visual inspection of sumps is only required in sumps where an alarm has occurred in the past month for which there is no <br /> service record. <br /> Y N -' <br /> Sum Location: SuM Location: Y N <br /> Symp Location: Sump Location: <br /> j <br /> Sump Location: _ a Sump Location: <br /> 7 Spill containment structures are free of water, debris, and hazardous substance. <br /> E Y N I N/A I Y N N/A <br /> Tank 1 - Contents: 87 1 ITank 3 - Contents: X <br /> Tank 2 - Contents: 91 1 1 X1 lTank 4 - Contents: X <br /> i 8 Under-dis ensercontainmetn areas are free of water, debris , and hazardous substance. Sensors Aare properl 1, <br /> Y N N/A Y N N/A <br /> Dispenser 1 / 2 Y I IDispenser 9 / 10 X <br /> Dispenser 3 / 4 Dispenser 11 / 12 X <br /> Dispenser 5 / 6 X Dispenser 13 / 14 X <br /> Dispenser 7 / 8 X Di s enser 15 / 16 <br /> PAPERWORK INSPECTION Y N N/A DATE DONE <br /> 9 Monitoring system certification has been completed within past 12 months . X 8114/2018 <br /> 10 Secondary containment tests have been completed within the required timeframe. X 8{g@/ A4g.. FS TV2 qya, <br /> 11 Spill containment structure bucket testing was completed within theast ear. X 8/14/2018 <br /> 12 Tank tightness testing was completed within required timeframe. <br /> 13 Line tightness testing was completed within required timeframe. <br /> 14 Other required testing/ maintenance was completed within required timeframe. List test/ maintenance items below. <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> FACILITY EMPLOYEE TRAINING Y N NIA <br /> 15 JAII facility em to ees have received the required on-the-'ob training within the past year, <br /> 16 All facility employees hired within the past 30 dayse have receved the required on-the-job training . <br /> Note: Any answer of "N" should be explainged in the comment section on the following page, <br /> and will require follow-up action. <br /> Signature <br /> DateJb <br />