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Site ID: 1300-1 <br /> 6 2nd Strut <br /> 4 Designated Operator <br /> Galt,Ca 95632 Monthly Inspection Checklist <br /> 209-7440112 Fax 209-7440116 <br /> Site:VAN DE POL - LODI PACIFIC PRIDE Date:5-11-18 <br /> 351 N. BECKMAN ROAD <br /> LODI , CA 95240 <br /> ❑Zane A.Nunmo ® David A.Winkler ❑Felix G.Ramirez ❑ Edward Stearns <br /> #8883064 #8883059 #8883072 #8883`080 <br /> Y= k-not anifeable <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 /> Attach a copy of the alarm hist report/logrepor0og to this orm'(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 momh. X <br /> List all tank-top sumps where alarm 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 approprlate service to this report Ifsump inspection is requireoC 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-tap containment sumps are free of water,debris,and hazardous substance.Sensors are located properly. <br /> Note:Visual tavection ofniams is in where an alanm has occurred A7 Ae pot mach for whk*there is no service record <br /> Sump Location:87 X Sump Location:RED DIESEL X <br /> Sump Location:91 X Sump Location: X <br /> Sump Location:DIESEL X Sump Location: X <br /> Sump Location:DIESEL X Sump Location: X <br /> Sump Location: X Sump Location: X <br /> S ill containment shuctm=are free ofwafer de ' &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- X <br /> Tank 4-Diesel X Tank 8- X <br /> Under containment free of water,debris,&hazardous substance.Sensors located <br /> Dispenser 1/2 X Dispenser 19/20 X <br /> Dispenser 3/4 X Dispenser 21 X <br /> Dispenser 5/6 X Dispenser 22121 X <br /> Dispenser 7/8 X Dispenser 23122 X <br /> Dispenser 9/10 X Dispenser24/23 X <br /> Dispenser 11/12 X Dispenser 25/24 X <br /> Dispenser 13/14 X Dispenser 26125 X <br /> Dispenser 15/16 X Dispenser 27126 Satellite X <br /> Dispenser 17/18 X Dispenser 27 X <br />