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Jul 21 06 12: 51p Afforda Test (209) 744-0116 p. 4 <br /> Afforda-T'e$t :M:o <br /> Designated Operator <br /> 800 524-9087 FAX 209 794-0112 nthly Ins ection Checklist <br /> Facili Name: i5j YUc ,i Date: ( p <br /> Facili Address: <br /> Ci 0L1(AZi Code:• Z <br /> O� <br /> Designated UST O rater Conductingthe ins ion: U�'O / !y <br /> International C6de ncil Certification#: .3 7 'U Ltz /ration Datc: - / S / !� <br /> Y—Yre.N—Nh NA N11 AppficnW <br /> Item MONITORING PANEL/ALARM HISTORY N NA <br /> Y <br /> I I Momtorin stem is powered on and m er operating ....,..41... <br /> mode. <br /> 2 Monitorin stem is not currently showing any alarms or wamia <br /> 3 Alarm history rep0r009 for the previous month is available,and has been reviewed by the )` <br /> Designated UST O Attach a copy o the alarm histo MeorOng to this orm i available. <br /> 4 Foch alarm for the previous month has been responded to appropriately. <br /> S Sensors located in tank-toj2 containment sumps have not alarmed in the past month. <br /> Sa L/st all tank-top sumps•where alarms occurred in the past month: <br /> Note:Snmpa where an ntarm bur a rnrred/n Ila pom n,"h mat be/n. Isd rrnlera o gnat/J/odxrvica Mchnlc/mr nsporMed Ia and <br /> proper/yaddrcved the cauve of/he alarm,Anwh dontmenwrion verood"g oppropr/ale serv/ee m chis report. <br /> nim les emlon Ism aired record randlr/n thm 6,betm.. <br /> UST SYSTEM INSPECTION <br /> 6 Tank-top containment sumps are free of water,debris,and hazardous substance. Sensors are located properly, <br /> time: Vlrrud lea ton n rum ala aldy rc o/rcd/n cam whereon alarm tai ocnrrred/n ire nmmh ar which there is m service record. <br /> Y N �.. <br /> Sum Location: O ledo ,5, , <br /> Sum /.peaJlon: �.. . <br /> Stun 555 <br /> Location: o . b Sum Location: ,•, <br /> Sum Location: Sum Location: ,• <br /> 7 S all containment stmcrw,,are free of water debrisa and hazardous subctancc. <br /> Y N NA N NA <br /> Y <br /> Tank 1—Content— -1 Tank 3—Contents: <br /> Tank 2—Contents: .rj Tank 4—Contents: ' <br /> 8 Under-dis nser containment areas are free of water debri and hazardous substance. Sensors are located roperly. <br /> Y N NA N NA <br /> Y <br /> Dis nser 1/2 U e k Dis nser 9110 <br /> Dle nser 3/4 �._ 1e Dis oxer 11/11 <br /> Dis nser S/6 Dir enser 13/14 <br /> Dir nser 7/8 DI s nser/5/16 / <br /> PAPERWORK INSPECTION N NA DATE DONE <br /> X <br /> 9 Monitorin s stem certification has been�Completed within act 12 months. <br /> 10 Second containment tests have been completed within the required timeframe. X 12 't D <br /> 1 I S ill containment satr,h,, bucket testis was-completed within the est ear. <br /> 12 Tank ti Loess testin was eom leted within rc aired timeframe, y <br /> I3 Line ti mess testis was completed within re aired timeframe. y <br /> 14 _Other required tes[invJmaintenance wan completed within required timcframe. /fist iest/mointenonce.items <br /> Te.rl/Maintenance: <br /> Tesl/Maintanance: y <br />