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Site ID: 1010-6 <br /> A 4f 6 2pd d St Street t Designated Operator <br /> Gait,Ca 95632 Monthly Inspection Checklist <br /> 209-744-0112 Fax 209-744-0116 <br /> Site: C D&R- C J' S CHEVRON Date: 10/12/17 <br /> 7501 W. 11TH STREET <br /> - 2V <br /> TRACY , CA 95304 <br /> . ENVIROPE',IE1i;AL HEALTH <br /> ®Zane A.Nimmo David A.Winkler 4 - <br /> ❑ ❑Felice G.�Lamirez �] Edward Stearns <br /> #5263322 #5263373 #5273934 #5250492 <br /> NA=nota Iinbk <br /> MONI'T'ORING PANEL/ALARM HISTORY —V-75— <br /> Monitoring <br /> NMonitoring system is powered on and in proper operating mode. X <br /> Monitoring system is not currently showing any alarms or warnings. X <br /> 4— <br /> Alarm history report/log for the previous month is available,and has been reviewed by the Designated UST X <br /> Operator. Attach a copy of the alarm history report1logg to thisform if available.) <br /> Each alarm for the previous month has been responded to appropriately X <br /> Sensors located in tank-top containment sumps have not alarmed in the past month. HX <br /> ,List all tank-top sumacs where alarms occurred in the past month. <br /> Note:Sumps where an alarm has occurred in the past month must be inspected unless a qual#?ed service technician responded to,and properly <br /> addressed,the cause of the alarm-,attach documentation verifying appropriate service to this report.If sump inspection is required,record results <br /> in item 6,below. <br /> ,ASST SYSTEM INSPECTION <br /> X I N I NA I I Y N I NA <br /> Tank-top ootoinment sumps are free of water,debris,and hazardous substance. Sensors are located properly" <br /> Not: rL mal 1 tion s rs re "rad- where an alarm has ocamd in the past month for which there is no service record <br /> Sump Location:87 OCTANE S T P X Sump Location: X <br /> Sump Location:91 OCTANE S T P X Sump Location: X <br /> Sump Location:DIESEL S T P X Sump Location: X <br /> Sump Location: RANSI'TiON SUIS X Sump Location: X <br /> Sump Location: X Sump Location: X <br /> Spill containment structures are free of water,debris,&hazardous substance. <br /> Tank 1–87 OCTANE X Tank 5- X <br /> Tank 2–91 OCTANE X Tank 6- X <br /> Tank 3–DIESEL X Tank 7- X <br /> Tank 4- X Tank 8- X <br /> Under-dis)ewer containment free of water,debris,&hazardous substance.Sensors located properly. <br /> Dispenser 1/2 X Dispenser X <br /> Dispenser 3/4 X Dispenser X <br /> Dispenser 5/6 X Dispenser X <br /> Dispenser 7/8 X Dispenser X <br /> Dispenser 9/10 X Dispenser X <br /> Dispenser 11/12 X Dispenser X <br /> Dispenser 13/14 X Dispenser X <br /> Dispenser 15/16 X Dispenser X <br /> Dispenser 17118 X Dispenser X <br />