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Site ID:1010-6 <br /> Affords-rI'e$t <br /> Designated 2nd Street esignated operator <br /> Galt, Ca 95632 Monthly Inspection Checklist <br /> 209-744-0112 Fax 209-744-0116 <br /> , <br /> Site: CJ CHEVRON hate: 6/2/17 <br /> r-17 20 <br /> 11TH STREET <br /> ER'VIRON.`-AEgi,ALI HEALTH <br /> TRACY, CA 95337 PERMIT/SERVICES <br /> ❑Zane A.Nig mo ® David A.Winkler ❑Felix G.Ramirez ❑ Edward Stearns <br /> #5263322 #5263373 #5273934 #5250492 <br /> Y= a N=no,NA=n6fikoplicable <br /> MONITORING PANEL/ALARM HISTORY X N KA <br /> Monitoring systems 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 c2a o the alarm history reportqog to this orm if available. <br /> Each alarm for the previous maontb 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 month mast be inspected unless a qualified service technician responded to,and properly <br /> addressed,the cause of the alarm.Attach documentation verifyi+lg appropriate service to this report tfsump inspection is required record results in <br /> item 6,below. -1111 <br /> AST SYSTEM INSPECTION <br /> X I N NA Y I N NA <br /> Tank-top containment sumps are iree of water,debris,and hazardous substance.Sensors are located properly. <br /> Note:rtsual inspection qf4ump3 u only required tosumps where an alarm has occurred to the pot month or which there is no service record <br /> Sump Location,87 X Sump Location: <br /> Sump Location:91 X Sump Location: <br /> Sump Location:DSLX Sump Location: <br /> Spill containment structures are free of water,debris &hazardous substance. <br /> Tank 1 -Regular X Tank 5- X <br /> Tank 2-plus X Tank 6- X <br /> Tank 3-Premium X Tank 7- X <br /> Tank 4-Diesel X Tank 8- X <br /> Under-dispenser containment free of water,debris,&hazardous substance.Sensors located properly- <br /> Dispenser 112 X Dispenser 19/20 X <br /> Dispenser 314 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 Dispenser 26/25 X <br /> Dispenser 15/16 X Dispenser 27/26 Satellite X <br /> Dispenser 17/18 X Dispenser 27 X <br />