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UST OPERATOR MONTHLY INSPECTION <br /> Facility Name:French Camo Cardlock <br /> Facility Address:10842 S.Harlan Rd J IJ�i 24 <br /> City/State/Zip:French Camp <br /> Designated UST Opgrator:Stev richardson hone:916-371-2570E' !'4" r-%I.TH <br /> ICC Certificati Nu 18604 Expiration Date:8-29-15 <br /> Signature: Date: L( <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. 0 El 0 <br /> 4 Each alarm for the previous month has been responded to appropriately. 0 El 11 <br /> 5 Sensors located in tank-top containment sumps have not alarmed in the past month. S 11 El <br /> Note: Sumps where an alarm has occurred in the past month must be inspected unless a qualified service technician respond to,and properly addressed,the cause of the <br /> alarm. Attach documentation veri nitrate service to this re rt. If sum insction is re erred,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 sumps is only required in sumps where an alrm has occurred inthe past month for which there is no service record. <br /> Y I N I N/A Y N N/A <br /> Sump Location: [1 0 El Sump Location: 0 El El <br /> Sump Location: Fl El [I Sump Location: 11 F1 11 <br /> Sump Location: El El El Sump Location: 11 El El <br /> Sump Location: El E] 11 Sump Location: El 0 E] <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:-0. �'C— [I El Tank 6–Contents: ❑ El 11 <br /> Tank 2–Contents: El D 0 Tank 7–Contents: El 0 El <br /> Tank 3–Contents: n F1 El Tank 8–Contents: 11 0 11 <br /> Tank 4–Contents: 0 D El Tank 9–Contents: El El El <br /> Tank 5–Contents: El 0 El Tank 10–Contents: ❑ El 0 <br /> 8 Under-dispenser containment areas are free of water,debris,and hazardous substance. Sensors are located properly. <br /> Y N N/A Y N N/A <br /> Dispenser#J17_&14, V, El El Dispenser# El El El <br /> Dispenser# I7 C14Z_ M E] Dispenser# <br /> — 7- <br /> Dispenser# _W r; El El Dispenser# n <br /> 7 4,1) % <br /> Dispenser# TA 11 El Dispenser# El El 1:1 <br /> Dispenser# Dispenser# ❑ 1:1 El <br /> Dispenser# 17 El I Fl Dispenser# El 1:1 El <br /> Dispenser# ❑ [I El Dispenser# El El El <br /> IMME IMME <br /> P.O.BOX 401,W SACRAMENTO,CA 95691 (800)477-7266 <br />