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Site ID: 1010-6 <br /> Affolyda-Te$t <br /> 416 20dstreet Designated Operator <br /> Gait,Ca 95632 Monthly Inspection Checklist <br /> 209-744-8112 Fax 209-744-0116 <br /> Site: CD&R—CJ'S CHEVRON a Date: 10-04-16 <br /> 7501 W 11TH ST <br /> TRACY,CA 95304 <br /> ❑Zane A.Nlmmo ❑David A.Winkler ®Felix G.Ramirez ❑ Edward Stearns <br /> #5263322 #5263373 #5273934 #5250492 <br /> X= es K—n IVA=nota livable <br /> MONITORING PANEL/ALARM HISTORY Y 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 reportilog for the previous month is available,and bas been reviewed by the Designated UST X <br /> O erator. Attach a copy o the alarm history repon4og to thi3form i available. <br /> Each alarm for the previous month has been responded to appropriately $ <br /> Sensors located in tank-top containment sumps have not alarmed in the pest month. X <br /> List all tank-top sumps where alarms occurred in the putt month: <br /> Note:Sumps where an arm occurred Ire the part month m usr inspects wtless d tlraalified service h clan resporrdsd m,andproperly <br /> undressed the cause of the alarnc attach docwwWation veerifying apprgvidte service to this report,!f swap bupectipn is required record results In <br /> item 6, below. <br /> AST SYSTEM INSPECTION <br /> Y I N I NA I X N NA <br /> 3'anlc-top containment sumps are free of water,debris,and hazardous substance,Sensors are located properly. <br /> Note:Viswi r ecuon ofsmps is M where 4w alarm has occurred in the paul wommforwhwh Acre is no service record <br /> Sump Location:VAPOR X I I I Sump Location: ' X <br /> Sump Location: L I I X ISump location: X <br /> Sump Location: p Location: X <br /> Spill containment structures are fxee of water debris,&hazardous substance. <br /> Tank 1-,Regular X Tank 5- X <br /> Wank 2—Plus X Tank 6- <br /> X <br /> Tank 3-Premium X Tank 7- X <br /> Tank 4-Diesel X Tank 8- X <br /> Under-dis eraser 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 Dispenser 23/22 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 />