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A.ffoarda-Telt Site id: 1010-6 <br /> 416 2nd Street Designated Operator <br /> Galt,Ca 95632 Monthly Inspection Checklist <br /> 209-744-0112 Fax 209-7440116 <br /> Site: CD&R—CJ'S CHEVRON ' ` <'" Date: 114.16 <br /> 7501 W. X 1T"STREET <br /> TRACY CA 95304 <br /> ❑Zane A.Niumino ®David A.Winkler ❑Felix G.Ramirez ❑ Edward Stearns <br /> #5263322 #5263373 #5273934 #5250492 <br /> Y N=aoNA=zatapj4jcabje <br /> MONITORING PANEL/ALARM HISTORY Y N N,k <br /> Monitoring system is powered on and in proper operating mode. X <br /> Monitoring system is not currently showing any alarms or warnings. <br /> Alarm history report/log for the previous.month is available,and has been reviewed by the Designated UST X <br /> erator. Attach a copy of the alarm histor <br /> y report/logreporifiog to this orm 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. <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 aqua ' ed service technician responded to,and proper <br /> addressed,the cause of the alarm Attach documentation verifying appropriate service to this report.If sump inspection is requirv4 record results in <br /> tttm 6 below. <br /> AST SYSTEM INSPECTION <br /> Y N INA IY N NA <br /> Tank-top containment sumps are free of water,debris,and hazardous substance.Sensors are located properly. <br /> Note:Vtmed inspection ofswrips is only required fnsumps where an atom has occurred in the past month or which there is mo service record <br /> Sump Location:87 X Sump Location: <br /> Sump Location_91 X Sump location: <br /> Sump Locetion:DSL X Sump Location: <br /> LA <br /> Spill containment structures are free of water,debris,&hazardous substance. <br /> Tank 1—RegularTank 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 Eroperly. <br /> Dispenser 1/2 X Dispenser 19/20 X <br /> Dispenser 3/4 X Dispenser 21 v 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 /> Dispcnser 17/18 X Dispenser 27 X <br />