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Afforda-Te$t Site ID:1010-6 <br /> 416 2nd Street Designated Operator <br /> Galt,Ca 95632 Monthly Inspection Checklist <br /> 209-744-0112 Fax 209-744-0116 <br /> Site: CD&R OIL- CJ CHEVRON - Date: 3-7-16 <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 /> 01 <br /> V <br /> Y= es N=no,NA=not appticable <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 report/log for the previous month is available,and has been reviewed by the Designated UST X <br /> Operator. (Attach a copy of the alarm history report/logreportlZog to this form i 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. 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 must he inspected unless a qualified service technician responded to, and properly <br /> addressed, the cause of the alarm.Attach documentation verifying appropriate set-vice to this report.Ifsump inspection is required, record results <br /> in item 6,below. <br /> AST SYSTEM INSPECTION <br /> Y I N I NA I I Y I N NA <br /> Tank-top containment sumps are free of water,debris,and hazardous substance. Sensors are located properly. <br /> Note:Visual inspection o sum s is only required in sum s where an alarm has occurred in the past month%r which there is no service record. <br /> Sump Location:87 X Sump Location: <br /> Sump Location:91 X Sump Location: <br /> Sump Location:DSL X Sump Location: <br /> Sump Location: Sump Location: <br /> Sump.Location: Sump Location: <br /> Spill containment structures are free of water,debris,&hazardous substance. <br /> Tank 1—Regular X Tank 5- <br /> Tank 2—Plus X Tank 6- <br /> Tank 3-Premium X Tank 7- <br /> Tank 4-Diesel X Tank 8- <br /> Under-dispenser 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 Dispenser23/22 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 />