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[--:,—,Afforda-Te$t Designated Operator <br /> 416 2nd Street Galt, Ca. 95632 Monthly Inspection Checklist <br /> L12O9 744-0112- 800 524-9087 - Fax 209 744-0116 <br /> D <br /> Site: ate: <br /> Designated Operatorlu David Winkler ICC # 5263373-UC Expiration: 313108 <br /> "Signature Y=yes N=no NA=not applicable <br /> Y N A <br /> ILSTD-11Y <br /> L : L <br /> mode. <br /> an alarms or <br /> A�— <br /> Ala histo report for the previous month is available and has been reviewed by D.D. <br /> (Attach alarm history,if available) <br /> Each alarm for the previous month has be <br /> -Sensors located in tank-top-containment sumps have not alarmed in the past month. <br /> List all tank-top sumps where alarms occurred in the past month: TIQ &I 1P/i"N I <br /> Note:Sumps where an alarm has occurred in the past month must be inspected unless a qualified service technician responded <br /> to,and properly addressed, the cause of the alarm. Attach documentation verifying appropriate service to this report. <br /> Lsunto ins pection.Mis i <br /> _Le��uired, record results in item#6 below. <br /> HEMEMEMEMENE11REM' ;i:i;"a's i i ii gw1, lin <br /> UST SYSTEM INSPECTION <br /> —1 F--r I N INAI I YLN NA <br /> L <br /> T I hank-to�p containment sumps are free of water, debris, and hazardous substance. Sensors located properly. <br /> * . ='i. 0,:.Ps 0,, <br /> Note: Visual inspection of sumps only required in sumps where an alarm has occurred in the past month for which there is no service record. <br /> -Sumv location: Sump location: <br /> .-Sum Elocation: Sump location: <br /> Sump location: ' Sump location: <br /> Spill contaimnent structures are free of water, debris, &hazardous substance. <br /> Tank I -Regular I Tank 4-Diesel <br /> Tank 2- X Pitm- 16 ')C Tank 5- <br /> — ---L— �--——-- <br /> Tank 3-Premium Tank 6- <br /> Under- is <br /> Under-dis-p nser contaimnent free of water, debris, hazardous substance. Sensors located properly. <br /> Dispenser 1/2 Dispenser 19/20 <br /> Dispenser 3/4 Dispenser 21 ------- <br /> Dispenser 5/6 Dispenser 22/21 Satellite <br /> Dispenser 7/8 Dispenser 23/22 Satellite <br /> Dispenser 9/10 <br /> 1 0 'Dispenser 24/23 Satellite <br /> Dispenser 11/12 25/24 Satellite <br /> Dispenser 26/25 Satellite <br /> Dispenser 15/16 Dispenser 27/26 Satellite <br /> Dispenser 17/18 Dispenser 27 Satellite LL <br /> Facility Employee Training <br /> he-Job traiiiing within the mt eal�. <br /> All facility employees hired within the past 30 days have received the required on the job training -T-1 <br /> 71 <br />