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Designated Under ound Storage Tanis (UST) Operator <br /> Monthly Visual Inspection Checklist <br /> Facility Name: H&M Date : 07/ 11 / 18 <br /> Facility Address: 2501 E. Jackson Ave <br /> CitI Escalon Zip Code: 95320 <br /> Designate,d UST O orator Conductin the Ins ection: Karen R Arnaiz <br /> International , e Coun it ertilication #: 8356759 Ex iration Date: 03/30/ 19 <br /> Si tore: Phone: ( 209 ) 5184836 <br /> V = Yes N = No, NA = NotAepllcable <br /> Item TORING PANEL 1 ALARM HISTORY Y N NA <br /> l Monitoring system is powered on and in )roper o eratin mode . Mmonth. <br /> X <br /> 2 Monitoringsystem is not currentlyshown an alarms or warnings. X <br /> 3 Alarm history reporft for the previous month is available, and has bee X <br /> Desi ated UST O orator. Attach a co o the alarm histo re ort/lvailable. X <br /> 4 Each alarm for the previous month has been res onded to a ro riatel X <br /> 5 Sensors located in tank-to containment sumps have not alarmed in the past <br /> 5a List all tank-top sumps where alarms occurred in the past month <br />€: Note: Sumps where an alarm has occurred in thepast month must be inspected unlessaqtechnician responded to, and <br /> properly addressed, the cause of the alarm, Attach documentation verging appropriate service to this report. <br /> Itsump Inspection is i1equireA record results in item 6, below. <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 o sum s is onl required in sumps where an alarm has occurred in the past month or which there is noYservice coni <br /> Y N <br /> Sum Location: 87 STP X <br /> - Sum Location: 91 STP X <br /> Sum Location: Diesel STP X <br /> 7 S ill containment structures are free of water, debris, and hazardous substance. YN NA <br /> Y N NA X <br /> Tank I — Contents: 87 X Tank 3 — Contents: Diesel <br /> Tank 2 — Contents: 91 X <br /> 8 Under-dis enser containment areas are free of water, debris, and hazardous substance. Sensors are locatedprop�1 NA <br /> Y N NA <br /> Dis enser 1 / 2 X <br /> Dis eraser 3 / 4 X <br /> PAPERWORK INSPECTION Y N NA DATE DONE <br /> 9 Monitore�g system certification has been completed within ast 12 months. X 08/30/17 <br /> 10 Second containment tests have been completed within the required timeframe. X 08/30/ 17 <br /> 11 Spill containment structure (bucket) testin was com leted within the ast ear, X 0 $/30/17 <br /> 12 Tankfightress testing was completed within required timeframe. <br /> 13 Line ti tress testing was completed within re uired timeframe. <br /> 14 Other required testinglinaintenance was completed within required timeframe. List test/maintenance items below. <br /> Test/Maintenance: <br /> Test/Maintenance: <br /> Test/Maintenance: 11 <br /> IIIFACILITY EMPLOYEE TRAINING Y N NA <br /> 15 All facili em 10 ees have received the required on-the-' ob traim g within the past year, 05/ 17/18 X <br /> 16 All facili employees hired within the past 30 days have received the re uired on-the-' ob training. X <br /> Note: Any answer of "N" should be explained in the comment section on the following page, and wilt require <br /> follow-up action. <br /> Pagel of 2 November 2004 <br />