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0 9 <br /> USS OPERATOR MONTHLY INSPECTION , <br /> Facility Name:French Camp Cardlock <br /> Facility Address:10842 S.Harlan Rd <br /> Ci ty/State/Zip:French Camp <br /> Designated UST Operator:Steven richardson Phone:916-371-2570 <br /> ICC Certification,Number.8218604 Expiration Date:8-29-15 <br /> Signature: C e , Date: <br /> Item MONITORING PANEL/ALARM HISTORY Y N N/A <br /> 1 Monitoring system is powered on and in proper operating mode. ® ❑ ❑ <br /> 2 Monitoring system is not currently showing any alarms or warnings. ® ❑ ❑ <br /> 3 Alarm history report/log for the previous month is available,and has been reviewed by the Designated UST Operator. ® ❑ ❑ <br /> 4 Each alarm for the previous month has been responded to appropriately. ® ❑ ❑ <br /> 5 Sensors located in tank-top containment sumps have not alarmed in the past month. ® ❑ ❑ <br /> Note: Sumps where an alarm has occurred in the past month must Ix inspected unless a qualified service technician responed to,and properly addressed,the cause of the <br /> alarm. Attach documentation verif in a ro riate service to this report. If sum ins fiction is re uired,record results in item 6,below. <br /> UST SYSTEM INSPECTION <br /> 6 Tank-top containment sumps are free of water,debris,and hazardous substance. Sensors are located properly. <br /> Note: Visual inspection of sums is only required in sums where an afrm has occurred in the past month for which there is no service record. <br /> Y I N I N/A Y N N/A <br /> Sump Location: ❑ ❑ ❑ Sump Location: ❑ ❑ ❑ <br /> Sump Location: ❑ ❑ ❑ Sump Location: ❑ ❑ ❑ <br /> Sump Location: ❑ ❑ ❑ Sump Location: ❑ ❑ ❑ <br /> Sump Location: ❑ ❑ ❑ Sump Location: ❑ ❑ ❑ <br /> 7 Spill containment structures are free of water,debris,and hazardous substance. <br /> Y N N/A Y N N/A <br /> Tank 1—Contents: DFC ® ❑ ❑ Tank 6—Contents: ❑ ❑ ❑ <br /> Tank 2—Contents: ❑ ❑ ❑ Tank 7—Contents: ❑ ❑ ❑ <br /> Tank 3—Contents: ❑ ❑ ❑ Tank 8—Contents: ❑ ❑ ❑ <br /> Tank 4—Contents: ❑ ❑ ❑ Tank 9—Contents: ❑ ❑ ❑ <br /> Tank 5—Contents: ❑ ❑ ❑ Tank 10—Contents: ❑ ❑ ❑ <br /> 8 Under-dispenser containment areas are free of water,debris,and hazardous substance. Sensors are located properly. <br /> Y I N N/A Y N N/A <br /> Dispenser# & El ElDispenser# El El 1:1 <br /> Dispenser# ❑ ❑ Dispenser# ❑ ❑ ❑ <br /> Dispenser# ,� �3 ❑ ❑ Dispenser# ❑ ❑ ❑ <br /> Dispenser# 3J q <br /> ® ❑ ❑ Dispenser# ❑ ❑ ❑ <br /> Dispenser# 4 a f E51 ❑ ❑ Dispenser# ❑ ❑ ❑ <br /> Dispenser# ❑ ❑ Dispenser# ❑ ❑ ❑ <br /> Dispenser# ❑ ❑ ❑ Dispenser# ❑ ❑ ❑ <br /> 3 LwL:n <br /> 4 <br /> P.O.BOX 401,W SACRAMENTO,CA 95691 <br /> b <br /> VV <br />