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Ci*a Irl• 17G,< <br />Afforda-Test <br />4162 ,d street Designated Operator <br />Galt, Ca 95632 M n hl Ins ection Checklist <br />209-744-0112 Fax 209-744-0116 <br />Fast N Easy #16 <br />1399 E Yosemite Ave <br />Manteca CA <br />❑ Lyle D. Nimmo <br />#5249115 <br />Signature: <br />❑ Zane A. Nimmo <br />#5263322 <br />AUG 12 2013 Date: 7-15-13 <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />® David A. Winkler ❑ Felix G. Ramirez <br />#5263373 #5273934 <br />V = vac N = nn_ NA = not nnniir hla <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 history report/logreport/log to thisform 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. If sump inspection is required, record results <br />in item 6, below. <br />UST SYSTEM INSPECTION <br />Y I N I NA I I <br />Y I N I 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 or which there is no service record. <br />Sump Location: 87 g Sump Location: <br />Sump Location: 91 g Sump Location: <br />Sump Location: ds] g Sump Location: <br />iiiiiiiiiiiiiiiiji <br />Spill containment structures are free of water, debris, & hazardous substance. <br />Tank 1 - Regular X Tank 4 - Diesel <br />X <br />Tank 2 — Tank 5 — WASTE OIL <br />Tank 3 - Premium X Tank 6 - <br />Under -dispenser containment free of water, debris, & hazardous substance. Sensors located properly. <br />Dispenser 1/2 X <br />Dispenser 3/4 X <br />Dispenser 5/6 X <br />Dispenser 7/8 X <br />