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0 <br /> Site ID: 1300-1 <br /> Afforda-Te$t <br /> 4162 d Street Designated Operator <br /> Galt, Ca 95632 Monthly Inspection Checklist <br /> 209-744-0112 Fax 209-744-0116 <br /> Site: VANDER POL PAC PRIDE _ bats -06-11 <br /> 351 N BECKMEN RD <br /> JUN 7 2011 <br /> LODI CA 95240 <br /> F] Lyle D.Nimmo F-1 Zane A.Nimmo F-1 David A.Wl�er „ ix G.Ramirez <br /> #5249115 #5263322 #5263373 #5273934 <br /> Signature: �. <br /> Y=yes N=no NA=not applicable <br /> MONITORING PANEL/ALARM HISTORY Y N NA <br /> Monitoring system is powered on and in proper operating mode. X <br /> Monitoring system is not currently showing any alarms or warnings. X <br /> Alarm history report/log for the previous month is available,and has been reviewed by the Designated UST X <br /> Operator. Attach a copy o the alarm history reportl7og to thisform i available. <br /> Each alarm for the previous month has been responded to appropriately X <br /> Sensors located in tank-top containment sumps have not alarmed in the past month. X <br /> List all tank-top sumps where alarms occurred in the past month: <br /> Note:Sumps where an alarm has occurred in the past month must be inspected unless a qualified service technician responded to,and properly <br /> addressed,the cause of the alarm.Attach documentation verifying appropriate service to this report.If sump inspection is required,record results <br /> in item 6,below. <br /> UST SYSTEM INSPECTION <br /> Y I N I NA I I Y I N NA <br /> Tank-top containment sumps are free of water,debris,and hazardous substance.Sensors are located properly. <br /> Note: Visual inspection o sum s is only required in sum s where an alarm has occurred in the past month or which there is no service record. <br /> Sump Location: 87 X Sump Location:RED DIESEL X <br /> Sump Location:91 X Sump Location: <br /> Sump Location:DIESEL X Sump Location: <br /> Sump Location:DIESEL X Sump Location: <br /> Sump Location: I I I Sump Location: <br /> Spill containment structures are free of water,debris,&hazardous substance. <br /> Tank 1 -Regular X Tank 5—RED DIESEL X <br /> Tank 2—Plus X Tank 6-DIESEL X <br /> Tank 3-Premium X Tank 7- <br /> Tank 4-Diesel X Tank 8- <br /> Under-dispenser containment free of water,debris,&hazardous substance.Sensors located properly. <br /> Dispenser 1/2 X Dispenser 19/20 <br /> Dispenser 3/4 X Dispenser 21 <br /> Dispenser 5/6 X Dispenser 22/21 <br /> Dispenser 7/8 X Dispenser 23/22 <br /> Dispenser 9/10 Dispenser 24/23 <br />