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Afforda-M i't Desi--ated Operator <br /> 800 524-9087 FAX 209 794-0112 . Monthly. ..tspection Checklist <br /> 1(b.ri <br /> Facili Name: J F u E l P r LP r <br /> Facili Address: f 5 1 0 Date: <br /> l �� <br /> l Ci (t ; Zi Code: 9 5 3 0�r� <br /> Desi nated UST O erator Conductingthe Inspection: k'o' er-j� F?owm o_n <br /> International Code Council Certification#: 2 ' q 13-3 - U C Ex iration Date: <br /> Signature: <br /> Phone: <br /> Item MONITORING PANEL/AL No,NA=Not A licable <br /> ARM HISTORY N NA <br /> Y <br /> I Monitorin s stem is owered on and in proper operating mode. <br /> 2 Monitoring <br /> stem is not currently showing any alarms or warnings. k <br /> 3 Alarm history report/log for the previous month is available,and has been reviewed by the <br /> Desi ated UST O erator. (Attach a co gf the alarm history report/7oreportl7og to this form i available.) SC <br /> 4 Each alarm for the nrPuioUs month has been responded to a ro riatel . <br /> 5 Sensors located in tank t02 containment sumps have not alarmed in the past month. X <br /> 5a _ 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 <br /> properly addressed,the cause of the alarm.Attach documentation verging appropriate service to this report. <br /> I slimP ins ection is required,record results in item 6 belmv. <br /> UST SYSTEM INSPECTION <br /> 6 Tank-top containment sumps are free of water,debris,and hazardous substance. Sensors are located properly. <br /> Note: Visual inspection of--mos is on re uired in sum where an alarm has occurred in the t month or which there is no service record. <br /> Y N �` <br /> N <br /> Sum Location: ( � T <br /> r <br /> Sum Location: <br /> / a Sum Location: ( F <br /> Sum Location: q ( F!;r 1 k t <br /> Sum LocatioSum Lation: <br /> n: n . <br /> 7 S ill containment structures are free of water,debris,and phazardousubstance. <br /> m:. <br /> Y N NA N NA <br /> � <br /> Tank 1—Contents: �� V <br /> Tank 3—Contents: n'rr ,,f <br /> Tank 2—Contents: y Tank 4—Contents: Cf <br /> 8 Under-dis eraser containment areas are free of water,debris,and hazardous substance. Sensors are located to erl . <br /> Y N NA N NA <br /> Y <br /> Dis enser I/2 `< Dis eraser 9/!0 <br /> Dis enser 3/4 x' Dis enser 1!/12 <br /> Dis enser 5/6 f <br /> K <br /> Dispenser 7 8 Dis enser 13/14 <br /> / <br /> „a. Drs enser 15/16 <br /> PAPERWORK INSPECTION N NA DATE DONE <br /> Y <br /> 9 Monitorin9 s stem certification has been completed within past 12 months. y' <br /> 10 Second containment tests have been com feted within the required timeframe. X <br /> 11 S ill containment structure(bucket)testis was completed within the Dast year. X ) ^} <br /> 12 Tank ti tress testingwas completed within required timeframe. — <br /> 13 Line ti tness ISsgp&was complete I within required timeframe. <br /> 14 Other required testis maintenance was completed within required timeframe. (List test/maintenance items below. <br /> Test/Maintenance: <br /> Test/Maintenance: <br />