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JIM <br /> e , e <br /> UST OPERATOR T INSPECTION r <br /> . x <br /> Facility Name:French Camo Cardlock <br /> Facility Address:10842 S.Harlan Rd ,a <br /> City/State/Zip:French Camp <br /> Designated UST Ope teven richardson Phone:916-371-2570 i_° p ,! I,` 1_ t s fkL 9 <br /> ICC Certificati Nu r:8218604 Expiration Date:8-29-15 y <br /> Signature: 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 repordlog 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 be inspected unless a qualified service technician respond to,and properly addressed,the cause of the <br /> alarm. Attach documentation veriin a roriate service to this report.If sum ins tion is required,record results in item 6,below. <br /> f <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 in the past month for which there is no service record. <br /> Y N I N/A Y N N/A <br /> Sump Location: El El 0 Sump Location: ❑ ❑ El <br /> Sump Location: Sump Location: ❑ ❑ <br /> Sump Location: El Sump Location: ❑ ❑ ❑ <br /> Sump Location: 11 = 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: ❑ 10F ❑ <br /> Tank 2—Contents: Tank 7—Contents: -0- <br /> Tank <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 N N/A I Y N N/A <br /> Dispenser# , 14 D El Dispenser# ❑ ❑ ❑ <br /> Dispenser# �. Dispenser# ❑ <br /> Dispenser# �� Dispenser# ❑ ❑ ❑ <br /> Dispenser# `� l r (' Ll U Dispenser# ❑ ❑ ❑ <br /> Dispenser# czx,�` e ❑ ❑ Dispenser# ❑ ❑ ❑ <br /> Dispenser# Dispenser# ❑ ❑ ❑ <br /> Dispenser# Dispenser# ❑ ❑ ❑ <br /> P.O.BOX 401,W SACRAMENTO,CA 95691 <br /> (800)477-7266 <br />