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�\`(Z ( Site ID:1010-6 <br />Afforda-Te$t Desi nated Operator <br />416 2nd Street g p <br />Galt, Ca 95632 Monthly Inspection Checklist <br />209-744-0112 Fax 209-744-0116 <br />Site: CJ CHEVRON <br />11TH STREET <br />-. Date: 8-24-15 <br />tl�i.:r'4 tip- ._a.J ... <br />TRACY CA CA 95304 <br />❑ Zane A. Nimmo <br />#5263322 <br />MONITORING PANEL / ALARM HISTORY <br />Y <br />•:,,;",.,-„_.- - a. <br />® David A. Winkler <br />❑ Felix G. Ramirez <br />rnt 7rrrnE T <br />❑ Edward Stearns <br />#5263373 <br />#5273934 <br />#5250492 <br />X <br />Alarm history report/log for the previous month is available, and has been reviewed by the Designated UST <br />Operator. (Attach a copy of the alarm histo re ort/lo to this orm if available) <br />X <br />Each alarm for the previous month has been responded to appropriately <br />Y = es N= o,NA=notapptisable <br />MONITORING PANEL / ALARM HISTORY <br />Y <br />N <br />NA <br />Monitoring system is powered on and in proper operating mode. <br />X <br />Monitoring system is not currently showing any alarms or warnings. <br />X <br />Alarm history report/log for the previous month is available, and has been reviewed by the Designated UST <br />Operator. (Attach a copy of the alarm histo re ort/lo to this orm if available) <br />X <br />Each alarm for the previous month has been responded to appropriately <br />X <br />Sensors located in tank -top containment sumps have not alarmed in the past month. <br />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 be inspected unless a qualified service technician responded to, and properly <br />addressed, the cause of the alarm. Attach documentation verifying appropriate service 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 of sumps is only required in sum s where an alarm has occurred in the past month for 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 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 <br />Dispenser 19/20 <br />Dispenser 3/4 X <br />Dispenser 21 <br />Dispenser 5/6 X <br />Dispenser 22/21 <br />Dispenser 7/8 X <br />Dispenser23/22 <br />Dispenser 9/10 <br />Dispenser 24/23 <br />Dispenser 11/12 <br />Dispenser 25/24 <br />Dispenser 13/14 <br />Dispenser 26/25 <br />Dispenser 15/16 <br />Dispenser 27/26 Satellite <br />Dispenser 17/18 <br />Dispenser 27 <br />