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Afforda-Te$t site ID: 1010-6 <br /> 416 201 street Designated Operator <br /> Galt,Ca 95632 Monthly Inspection Checklist <br /> 209-744-0112 Fax 209-744-0116 <br /> Site: CD&fit–CJ'S CHEVRON Date: 09-19-16 <br /> 7501 W 117H ST <br /> BIVR..� <br /> TRACY,CA 95304 PL.-- <br /> 0 <br /> L.❑Zane A.Niimmo ❑David A.Winkler N Fella G.Ramirez <br /> #5263322 #5263373 #5273934 ❑ Edward Stearns <br /> #5250492 <br /> cable <br /> MONITORING PANEL/ALARM HISTORY Y N NA <br /> Monitoring system 1s powered on and in proper operating mode. <br /> Monitoring system is not currently showing any alarms or warnings. X <br /> Alarm history repor0og for the previous month is available,sled leas been reviewed by the Designated UST X <br /> Operator. Attach a co o the alarm hist re roo to this rm ' 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 mons must be inspected unless a qualified service technician responded to,and properly <br /> addressed the cause of the alarm.Attach documentation verify*appropriate,service to this-re rt. <br /> item 6 below. Potf s+a+cp inspection is required record results in <br /> AST SYSTEM INSPECTION <br /> Y N NA Y N NA <br /> Tank-top containment sumps are free of watcr,debris,and hazardous substance.Sensors are located properly. <br /> Note:Ylywpi i tion of now td only re red in s where ana(arne hap ocewnd in Aeowt month few wtu there ism service recall <br /> Sump Location:87 X Sump I.00ation:VAPOR x <br /> Sump Location:91 X Sump Location: X <br /> Sump Location:DSL .X Sump location: X <br /> Spill containment structures are free of water,debris,&hazardous substance. <br /> Tank 1-Regular, X Wank 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 /> 11 <br /> Under-die eraser containment free of water debris &hazardous substance.Sensors locatedproperly, <br /> Dispenser 1/2 X Dispenser 1920 X <br /> Dispenser 3/4 X Dispenser 21 X <br /> Dispenser 5/6 X Dispenser 22/21 f—+— X <br /> Dispenser 7/8 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 2625 X <br /> Dispenser 15/16 X Dispenser 27x16 Satellite <br /> Dispenser 17/18 X I Dispenser 27 X <br />