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�s <br /> Site 0:1010-6 <br /> X416 2d Str eft et Designated Operator <br /> Galt, Ca 95632 Monthly Inspection Checklist <br /> 209-744-0112 Fax 209-744-011.6 <br /> Site: CD&R—CXS CHEVRON1 Date: 12-13-16 <br /> 1 I""STREET l <br /> TRACY CA. CA 95304 <br /> ❑Zane A.Nimmo ®David A.Wi Wder ❑Felix G.Ramirez ❑ Edward Stearns <br /> 1#5263322 #5263373 #5273934 #5250492 <br /> X a to N=no.NA=not amilitAk <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 mouth is available,and has been reviewed by the Designated UST ,X <br /> Operator. Attach a c9py of the alarm history reporillog to this form if available. <br /> Each alarm for the previous month has been responded to appropriately X <br /> Sensors located iu 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 /> ote:Sumps where an alarm has occurred in the past month mast be tnspected unless a qualffied service technician responded to,aced properly <br /> addressed,the cause of the alarm.ktach documentation ver ng appropriate service to this report.ffsamp inspection is required,raaord results <br /> in item ti below. <br /> AST SYSTEM YNSFECTION <br /> X I N I NA I I Y EN I NA <br /> Tank-top containment sumps are free of water,debris,and hazardous substance.Sensors are located properly. <br /> Note:Visual inspection ofagNM is only re 'red in s where an alarm has occ owd in the past month fZ which there is no service recon! <br /> Sump Loc ation:87 X Sump Location: <br /> Sump Location:91 X Sump Location: <br /> Sump Locafion-D§L X Sump Location: <br /> Sump Location: Sump Location: <br /> Sump Location: Sump Location: <br /> Spill containment structures are free of water,debris &hazardous substance. <br /> Tank l—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 /> Under4s enmr 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 Dispcnscr 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 />