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Sita ID: 1010-6 <br /> .A►.�orda-Te <br /> 416 211a Street Designated Operator <br /> Galt,Ca 95632 Monthly Inspection Checklist <br /> 209-744-01.1.2 Fax 209-744-011.6 <br /> Site: CD&R—CJ'S CHEVRON Date: 07-29-1.6 <br /> 7501 w 11TH ST <br /> TRACY, CA 95304 <br /> ❑Zane A.Nimmo ❑David A,'Winkler ®Felix G.Ramirez Edward Stearns <br /> #5263322 #52633173 #5273934 #5250492 <br /> ®nota cable <br /> MONITORING PANEL/,ALARM HISTORY Y N NA <br /> Monitoring systems 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 month is available,and has been reviewed by the Designated UST X <br /> Operator. Attach a copy othe alarm histo re orKog to this orm available. <br /> Each alarms for the previous month has been responded to appropriately X <br /> Sensors located in tank-top contain went 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 has occurred in the past month mart be inspected unless a qualified service technician responded to,and properly <br /> addressers the cause of the alarm.Attach documentation verging appropriate service to this report.Ysump inspection is required,record results in <br /> item d,belaw. <br /> AST SYSTEM INSPECTION <br /> Y I N I NA Y N N.A. <br /> Tank-top containment sumps are free of water,debris,and hazardous substance.Sensors are located properly. <br /> Noce:Visual inspection ofstimps it bvd#I s where an alarm has occurred in the Paut mmithfor which Owre is no,service record <br /> Sump Location:VAPOR X Sump Location: X <br /> Sump Location_ X Sump location: X <br /> Sump location: X Sump Location: X <br /> Spill containment structures are&ee of water,debris &hazardous substance. <br /> Tank l -Regular X I Tank 4-Diesel X <br /> Tank 2—Plus X Tank 5- X <br /> Tank 3 -Premiums X Tank 6- X, <br /> Under-ften containment free of water,debris,&hazardous substance_Sensors located property. <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 /> � t <br />