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Site ID:1010-6 <br /> Affoirda-Te$t <br /> 416 211d street Designated Operator <br /> Galt,Ca 95632 Monthly Inspection Checklist <br /> 209-744-0112 Fax 209-744-0116 <br /> Site: CJ CIIEVVRON ' � Date: 8-22-17 <br /> 7501 11 Tx STREET 20 <br /> ENVIRON',ir'_NTAL HEALTH <br /> TRACY, C,A.95304 PER!-!T/SERV'Ir"ES <br /> El Zane A.Nimmo ❑David A.Wivalder ®Felix G.Ramirez Fdward Stearns <br /> #5263322 #5263373 95273934 #5250492 <br /> VP <br /> X—yes N-no,NA-not applicable <br /> MONITORING PANEL/ALARM MSTORY 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 /> Operator. attach a copy o the alarm histo re ort/lo to this orm ' 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. X <br /> List all tank-top sumps where alarms occurred in the past month: <br /> Nore:Sumps where an alarm has occurred in the past month must be inspected unless a qualified 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 in <br /> item 6 below. <br /> AST SYSTEM INSPECTION <br /> X I N I NA X I N NA <br /> Tank-top containment sumps are free of water,debris,and hazardous substance.Sensors are located properly. <br /> Note: Visual oWction ofwW is qqLV reqwmdinsumps where an alarm has occurred to the past Afor which there is no service record <br /> Sump Location. VAPOR X Sump Location <br /> Sump Location: Sump Location'. <br /> Sump Location: Sump Location. <br /> Spill containment struatums are free of water,debris,&hazardous substance. <br /> Tank l—87 X Taa 5- X <br /> Tank 2—91 X Tank 6- X <br /> Tank 3- DIE X Tank 7- X <br /> Tank 4- X Tank 8- X <br /> Under ' er containment free of water,debris,&hazardous substance.Sensors located properly. <br /> Dispenser 1/2 X 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 Dispenser23/22 X <br /> Dispenser 9/10 X Dispenser 24/23 X <br /> Dispenser 11/12 X Dispenser 25124 X <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 />