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Ci+e In. 1')G_' <br />va� V. 1GJ <br />Afforda-Telt Designated Operator <br />4162 " `� Street g p <br />Galt, Ca 95632 Monthly Inspection Checklist <br />209-744-0112 Fax 209-744-0116 <br />Fast N' Esv #16 <br />1399 e Yosemite Ave <br />Manteca CA 95336 <br />❑ Lyle D. Nimmo ❑ Zane A. Nimmo <br />#5249115 #5263322 <br />Signature: �_j <br />RECEIVED Date: 6-28-13 <br />AUG 12 2013 <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />® David A. Winkler ❑ Felix G. Ramirez <br />#5263373 #5273934 <br />V- N- NIA - ..1:....1.1.. <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/logreportllog 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. !f sump inspection is required, record results <br />in item 6, below. <br />UST SYSTEM INSPECTION <br />Y I N I NA I <br />Y N I NA <br />Tank -top containment sumps are free of water, debris, and hazardous substance. Sensors are located properly. <br />Note: usual inspection of sumps 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 x Sump Location: <br />Sump Location: 91 x Sump Location: <br />Ll <br />Sump Location: dsl x Sump Location: <br />Spill containment structures are free of water, debris, & hazardous substance. <br />Tank I - 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 />