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� r <br /> Site ID: 1574-1 <br /> Afforda-Te$t Designated Operator <br /> 4162"d Street g p <br /> Galt,Ca 95632 Monthly Inspection Checklist <br /> 209-744-0112 Fax 209-744-0116 <br /> Site: STOCKTON NP GAS Date: 12/15/16 <br /> 713 N ELDORADO STREET <br /> STOCKTON- ( A 95202 <br /> ❑ Zane A. Ninuno ❑ David A. Winkler ❑ Felix G. Ramirez ® Edward Stearns <br /> #5263322 45263373 #5273934 #5250492 <br /> V <br /> Y=yes N=no.NA=not a r rlicaMc <br /> MONITORING PANEL/ALARM HISTORY Y N NA <br /> Monitoring system ;s 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 of the alarm history report/log to thisorm i available.) <br /> Each alarm for the previous month has been responded to appropriately X <br /> Sensors 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 qualified service technician responded to,and properly <br /> addressed,the cause o0he alarm.Attach documentation verifying appropriate service to this report.If sump inspection is required,record results in <br /> item 6,below. <br /> UST SYSTEM INSPECTION <br /> Y I N I NA LY I N NA <br /> Tank-top containment sumps are free of water,debris,and hazardous substance.Sensors are located properly. <br /> Note:visual inspection o sums is only required in sum s inhere an alarm has occurred in the past month or which there is no service record. <br /> Sump Location:L-8 87 FILL X Sump Location: X <br /> Sump Location:L-13 DIE FILL X Sump Location: X <br /> Sump Location: X Sump Location: X <br /> Spill containment structures are free of water,debris,&hazardous substance. <br /> Tank I —Regular X Tank 5- X <br /> Tank 2—Plus X Tank 6- X <br /> Tank 3-Premium X Tank 7- X <br /> Tank 4-Diesel X Tank 8- X <br /> Under-dispenser containment free of water,debris,&hazardous substance.Sensors located properly. <br /> Dispenser 1/2 X Dispenser 19/20 X <br /> Dispenser 3/4 X Dispenser 21 X <br /> Dispenser 5/6 X Dispenser 22/21 X <br /> Dispenser 7/8 X Dispenser23/22 X <br /> Dispenser 9/10 X Dispenser 24/23 X <br /> Dispenser 11112 X Dispenser 25/24 X <br /> Dispenser 13/14 X Dispenser 26/25 X <br /> Dispenser 15/16 X Dispenser 27/26 Satellite X <br /> Dispenser 17/18 X I Dispenser 27 X <br />