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4A 0 <br /> UST OPERATOR MONTHLY INSPECTION <br /> L <br /> Facility Name:French Camo Cardlock <br /> 1201117 <br /> Facility Address:10842 S.Harlan Rd <br /> City/State/Zip:French Camp <br /> ' <br /> Designated UST Operator:Steven richardson Phone:916-37 x`1570E <br /> 570 H;;A TH <br /> ICC Certification 7cr:82186046711 <br /> Expiration,,bate:8- <br /> 29-15 <br /> Signature: Date: ?—I Lk <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. 0 El 0 <br /> 3 Alarm history report/log for the previous month is available,and has been reviewed by the Designated UST Operator. Iff-EF 0 <br /> 4 Each alarm for the previous month has been responded to appropriately. 0 El 0 <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 responed to,and properly addressed,the cause of the <br /> alarm.Attach documentation veri i ini agiroir ate service to this rciort. if sum insiection is re iwired,record results in item 6,below. ENESEEMM <br /> UST SYSTEM INSPECTION <br /> 6 Tank-top containment sumps are free of water,debris,and hazardous substance. Sensors are located property. <br /> Note:Visual inspection of sums is only required in sumps where an alrm has occurred in the past month for which there is no service record. <br /> Y I N N/A Y N N/A <br /> Sump Location: n El [3 Sump Location: El 0 El <br /> Sump Location: ❑ El n Sump Location: EJ E3 El <br /> Sump Location: Sump Location: E3 0 E3 <br /> Sump Location: D El LJ Sump Location: 13 01 F-1 <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 0 Tank 6—Contents: El 13 El <br /> Tank 2—Contents: 0 D El Tank 7—Contents: _rr-0- El <br /> Tank 3—Contents: El Tank 8—Contents: n El n <br /> Tank 4—Contents: Tank 9—Contents: [] I n 11 <br /> LTank 5—Contents: 0 El D Tank 10—Contents: 13 1 13 El <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# 19-&,L4, ❑ Dispenser# _E1 ❑ E3 <br /> Dispenser# Dispenser# 13 0 11 <br /> Dispenser# _rF ❑ Dispenser# -0--rr El <br /> Dispenser# 0 0 El Dispenser# <br /> Dispenser# ❑ F1 Dispenser# El 0 0 <br /> Dispenser# [3 Dispenser# -0-10--E] <br /> Dispenser# 0 Dispenser# El El El <br /> IMSEEMENNEEMEMEMM <br /> P.O.BOX 401,W SACRAMENTO,CA 95691 (800)477-7266 <br />