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Site ID: 1010-6 <br /> .A,fforda-Te$t <br /> 416 2nA Street ,Designated Operator <br /> Galt,Ca 95632 Monthly Inspection Checklist <br /> 209-744-0112 Fax 209-744-0116 <br /> Site: CD&R-CJ CHEVRON Date: 8-29-16 <br /> 7501 W 11TH STREET <br /> TRACY,CA 95304 <br /> ❑Zane A.Nimmo ®David A.Winkler ❑Felix G.Ramirez ❑ Edward Stearns <br /> #5263322 #5263373 #5273934 #5250492 <br /> N=n NA=pot apalke We <br /> MONITORING PANEL/ALARM HISTORY X N I NA <br /> Monitoring system is powered on and in proper operating mode_ X <br /> Monitoring system is not currently showing any alarms or warnings. <br /> X <br /> Alarm history rcport/log for the previous month is available,and has been reviewed by the Designated UST X <br /> Operator. Attach a copy of the alarm hisiory rwrtllog to thisform ifavailable. <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 har occurred in the past month must be inspected unless a qua i d service technician responded to,and properly <br /> addresseg the cause of the alarm.Attach documentation verifying appropriate service to this report.{frump inspection is requirect record results in <br /> item 6 below. <br /> AST SYSTEM INSPECTION <br /> Y I N I NAA I I X N NA <br /> Tank-top containment sumps are free of water,debris,and hazardous substance.Sensors are located properly. <br /> Note:Visual LmWtion ofsurgm is on drAmw where an atarm ha oceavred in the pwt omni# or which there is no service record <br /> Sump Location.,87 X Sump Location: <br /> Sump Location:91 X Sump Location: <br /> Sump Locadon:DSL X Sump Location. <br /> �jl <br /> S ill containment structures are free of water,debris &hazardous substance. <br /> Tank 1—Regular X Tank 4-Diesel X <br /> Tank 2—Plus Tank 6- X <br /> Tank 3-Premium X Tank 7- X <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 5/6 X Dispenser 22/21 X <br /> Dispenser 718 X Dispenser23122 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 />