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0 Site: 1486 <br /> Afforda-Te$t Designated Operator <br /> 416 2 Street g p <br /> Galt, Ca 95632 Monthly Inspection Checklist <br /> 209-744-0112 Fax 209-744-0116 <br /> Site: SRH Date: 5-24-2016 <br /> 749 E CHARTER WAY <br /> STOCKTON CA 95206 <br /> ❑Zane A.Nimmo ®David A.Winkler ❑ Felix G. Ramirez ❑ Edward Steams <br /> #552^63332222 #52633733 #5273934 j#55250492 <br /> Y= es N=uo.NA=notavv1kSb1e <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 o the alarm history reporillog to thisform i available. <br /> Each alarm for the previous month has been responded to appropriately —k <br /> — <br /> Each <br /> 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 be inspected unless a quaked service technician responded to,and properly <br /> addressed, the cause of the alarm.Attach documentation verifying appropriate service to this report.If sump inspection is required record results <br /> in item 6, below. <br /> UST SYSTEM INSPECTION <br /> Y I N I NA I I Y N NA <br /> Tank-top containment sumps are free of water,debris,and hazardous substance.Sensors are located properly. <br /> Note:Visual ctton o s is refired to s where an alar has occurred in the t month or which there is no service record. <br /> Sump Location:87 XSump Location: <br /> Sump Location:DSL X Sump Location: <br /> Sump Location:91 X Sump Location: <br /> Spill containment structures are free of water,debris,& <br /> hazardous substance. <br /> Tank 1 -Regular X I Tank 4-Diesel X <br /> Tank 2—Plus X I Tank 5- <br /> Tank 3 -Premium I X I I I Tank 6- <br /> Under-dispenser <br /> - <br /> Under- ' enser containment free of water,debris,&hazardous substance.SensoMI <br /> tedproperly. <br /> Dispenser 1/2 X Dispens0 <br /> Dispenser 3/4 X Dispens <br /> Dispenser 5/6 X Dispens1 <br /> Dispenser 7/8 X Dispens2 <br /> Dispenser 9/10 Dispens3 <br /> Dispenser 11/12 Dispens4 <br /> Dispenser 13/14 Dispens25 <br /> Dispenser 15/16 Dispens26 SatelliteDispenser 17/18 Dispens <br />