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Site ID:1010-6 <br /> Affarda-Te$t <br /> 416 2111 StreetDesignated Operator <br /> Galt,Ca 95632 Monthly Inspection Checklist <br /> 209-744-0112 Fax 209-744-011.6 <br /> L�.(tri <br /> Site: CJ CHE'V'RON Date: 5-24-17 <br /> 11T" STREET <br /> - ENIVIR0N[,4EN TA L(iULTH <br /> TRACY, CA 95337 PERM,713ERViC.ES <br /> ❑Zane A.Nimmo Z David A.Wier 0 Felix G.Ramirez ❑ Fdward Stearns <br /> #5263322 05263373 #5273934 #5250492 <br /> X m va N—no.NA—aot appficabk <br /> MONITORING PANEL/ALARM IISTORY 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 repor0og for the previous month is available,and has been reviewed by the Designated UST X <br /> Operator. Attach a copy o the alarm history report4og 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. 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 qualified service technician responded to,and properly <br /> addressed the cause of the alarm.Attach documentation ver*ing appropriate service to this report.If sump inspection is required record resutts to <br /> Item 6,below. <br /> AST SYSTEM INSPECTION <br /> X N NA Y N NA <br /> Tank-top containment sumps are free of water,debris,and hazardous substance.Sensors are located properly. <br /> Note.,rtaual inipwdon ofsumjas is only re tired insumm where an alarm has occurred to the pmi month for which there is W service record <br /> Sump Location:87 XSump Location: <br /> Surnp Location:91 X Sump Location: <br /> Sump Location:DSL X Sump Location: <br /> ��Jg <br /> Spill containment structures are free of water,debris &hazardous substance. <br /> Tank 1 —Regular X Tank 5- X <br /> Tank 2—flus X Tank 6- X <br /> Tank 3-Premium X Tank 7- X <br /> Tank 4-Diesel X Tank 8- <br /> Under-dispenser <br /> -Under-dis enser 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 516 X Dispenser 22121 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 I Dispenser 27 X <br />