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Site Ib: 1010-6 <br /> Afforda-Test <br /> 416 21Md Street Designated Operator <br /> Galt,Ca 95632 Monthly Inspection Checklist <br /> 209-744-0112 Fax 209-7440116 <br /> Site: C D&R-C J' S CHEVRONDate• 9/14/17 <br /> �o <br /> 7501 W. 11"` STREET 2E7 <br /> TRACY , CA 95304 EA'VROP�'-,T dTAL HE;LTH <br /> PERV1T/0SERVI,.ES <br /> ®Zane A.Nimmo ❑David A.Winkler ❑l oRK G.Ftawirez D Edward Stearns <br /> #5263322 #5263373 #5273934 #5250492 <br /> CA <br /> Y� N—no NA.y not a lica'hlc <br /> MONITORING PANEL/ALARM HISTORY X N NA <br /> Monitoring system is powered on and in proper operating mode. X <br /> Monitoring system is not currently showing any alarms or warnings. X <br /> Alarm history report/log for the previous month is available,and has been reviewed by the Designated UST X <br /> erator. (Attach a copy ofthe alarm history report/logreport1log to this form ff 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 mouth. X <br /> List all tank-top sumps 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#led service technician responded to,cold properly <br /> addressed,the cause of the alarm.Attach documentation verifying appropriate service to this report.,lfsump inspection is r equireA record results <br /> in item 6,below. <br /> AST SYSTEM INSPECTION <br /> X I N N.A, Y N NA <br /> Tank-top containment sumps are free of water,debris,and hazardous substance.Sensors are located properly. <br /> Note:Yiswt k9mcdon o maxpi is only required in su where an alarm has occurred in the past numbhfur which them is no servics record <br /> Sump Location:87 OCTANE S T P X Sump Location: X <br /> Sump Location:91 OCTANE S T P g Sump Location: X <br /> Sump Location_DIESEL S T P X Sump Location: X <br /> Sump Location:TRANSITION SUMP X Sump Location: X <br /> Sump Location: I X I 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-dispex=containment fine of water,debris,&hazardous substance.Sensors located <br /> Dispenser 1/2 g Dispenser 19/20 X <br /> Dispenser 3/4 X Dispenser 21 X <br /> Dispenser 5/6 x Dispenser 22/21 X <br /> Dispenser 7/8 X Dispenser 23%22 X <br /> Dispenser 9/10 X Dispenser 24/23 X <br /> Dispenser 11/12 X Dispenser 25/24 <br /> Dispenser 13/14 X Dispenser 26/25 X <br /> Dispenser 15/16 X Dispenser 27/26 Satellite X <br /> Dispenser 17/18 X Dispenser 27 X <br />