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Site ID:1010-6 <br /> Afforda-Te$t Designated Operator <br /> 416 20d Street <br /> Gait,Ca 95632 Monthly Inspection Checklist <br /> 209-744-0112 Parc 209-744-0 .1.6 <br /> Site: C.1 CHEVRON Date: 7/21/17 <br /> 7501 11TH STREET <br /> TRACY, CA 95304 <br /> ®Zane A.Nimmo ❑David A.WinMer ❑Felin G.Ramirez ❑ ]Edward Stearns <br /> #5263322 #5263373 #5273934 #5250492 <br /> r <br /> X=yes N-no NA=not applicabit <br /> MONITOMG PANEL/ALARM HISTORY X N t 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 Loa o the alarm history reportllag to thisform Y 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 /> .Note:Sumps where an alarm has occurred in the past m onth must be inspectedunless 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 N NA I I X I N N.A. <br /> Tank-top containment sumps are free of water,debris,and hazardous substance.Sensors are located properly. <br /> Note:Yisual i cyan o s is on re bed in s where an alarm has occurred in thepast month or which there is no Service record. <br /> Sump Location:87 X Sump Location: 'transition sump X <br /> Sump Location:91 X Sump Location: <br /> Sump 1 ovation: <br /> IS <br /> X Swoop Location: I�La <br /> Spill containment structures are iiree of water,debris &hazardous substance. <br /> Tank 1-87 X Tank 5- X <br /> 'tank 2-91 X Tank 6- X <br /> 'tank 3- DIE X Tank 7- X <br /> 'yank 4- I X Tank 8- X <br /> Under-dispenser containment free of water,debris &bazardous substance.Sensors located pr9perly. <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 25/24 X <br /> Dispenser 13/14 X Dispensert27 <br /> X. <br /> Dispenser 15/16 X Dispenseratellite X <br /> Dispenser 17/18 X Dispenser 'X. <br />