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UST OPERATOR MONTHLY INSPECTION <br /> Facility Name:French Camo Cardlock Z G <br /> Facility Address:10842 S.Harlan Rd <br /> City/State/Zip:French Camp <br /> Designated UST Operator:Steven richardsonHFALTH <br /> hone:916-371-2570 <br /> ICC Certification Number:8218604 Expiration Date:8-29-15 t- <br /> Signature: Date: 2 <br /> Item MONITORING PANEL/ALARM HISTORY Y N N/A <br /> 4 <br /> 1 Monitoring system is powered on and in proper operating mode. <br /> 2 Monitoring system is not currently showing any alarms or warnings. Z El El <br /> 3 Alarm history report/log for the previous month is available,and has been reviewed by the Designated UST Operator. 19 El [] <br /> L4_ Each alarm for the previous month has been responded to appropriately. 01 n I ❑ <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 verif A airoiriate service to this re ort. If sum ins action is rciuired,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 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: [I El El Sump Location: El El 0 <br /> Sump Location: El [I El Sump Location: El 0 11 <br /> Sump Location: [I El El Sump Location: D El El <br /> Sump Location: El El El Sump Location. 11 El El <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 0 C) Tank 6—Contents: El 0 El <br /> Tank 2—Contents: El El El Tank 7—Contents: El 0 El <br /> Tank 3—Contents: C1 El El Tank 8—Contents: El El El <br /> Tank 4—Contents: El El El Tank 9—Contents: D El 11 <br /> Tank 5—Contents: F1 R El Tank 10—Contents: 11 El 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# 1-3&-t4- i El [__1 Dispenser# El El M <br /> Dispenser# �2 Dispenser# El El El <br /> Dispenser# J�T—Er E] Dispenser# El 1:1 0 <br /> Dispenser# L El [I Dispenser# El 1:1 El <br /> Dispenser# L)A El E:1 Dispenser# E] <br /> Dispenser# Dispenser# <br /> Dispenser# [:11 El [__1 I Dispenser# El 1 0 11 <br /> P.O.BOX 401,W SACRAMENTO,CA 95691 (800)477-7266 <br />