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Site Ila: 1010-6 <br /> Afforda-Te$t Di <br /> 416 2na Designated gated Operator <br /> Galt,Ca 95632 Monthly Inspection Checklist <br /> 209-744-0112 Fax 209-744-01.16 <br /> Site• CD&R-CXS CHEVRON <br /> Date: 06-15-16 <br /> 7501 W 11T" ST <br /> TRACY, CA 95304 <br /> ❑Zane A.Nimmo ❑David A.Winkler M Felix G.Ramirez- ❑ Edward Stearns <br /> #5263322 #5263373 #5273934 #5250492 <br /> Y ea N=oq NA=not applicable <br /> MONITORING PANEL/ALARM HISTORY Y N NA <br /> Monitoring system is powered on and in proper operating mode. X <br /> Monitoring system is mot currently showing any alarms or warnings. X <br /> Alarm history report/log for the previous mouth is available,and has been reviewed by the Designated UST X <br /> Operator. ,Attach a copy of the alarm history report/logreport1log to thisform if available. <br /> Each alarm for the previous month bias been responded to appropriately X <br /> Sensors located in tank-top cont8inment sumps have not alarmed in the past month. X <br /> List all tank-top sumps where alarms occurred in the past month.- <br /> Note, <br /> onth.None•Sumps where an alarm as occurred in the past month must be inspected unless a qualifted service technician responded to, properly <br /> addressed, the cause of the alarm.Attach documentation verifying appropriate service to this report.!f sump inspection is required record results <br /> M item 6,below. <br /> AST SYSTEM INSPECTION <br /> Y N N,A Y N N.A, <br /> Tank-top containment sumps are free of water,debris,and hazardous substance.Sensors are located properly. <br /> Noce:Koval 1wpection of summ is onlyibW to sit where an alarm has om+md to the past monthfor which there is no service record <br /> Sump location:VAPOR X Sump Location: X <br /> Sump Location: X Sump Location; X <br /> Sump Location: X Sunup location: X <br /> Spill containment structures are free of water,debris Bc hazardous substance. <br /> Tank 1 -Regular X Tank 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 oontainsnent free of water,debris,&hazardous substance.Sensors located <br /> Dispenser 1/2 X Dispenser 19x10 X <br /> Dispenser 3/4 X Dispenser 21 X <br /> Dispenser 5/6 X Dispenser 2=1 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 /> Disponser 13/14 X Dispenser 2625 X <br /> Dispenser 15/16 2LJ Dispenser 2726 Satellite X <br /> Dispenser 17/18 X I Dispenser 27 X <br />